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目的探讨一种特殊类型的心绞痛——走过心绞痛的临床特征及其发病机制。方法连续观察和记录住院冠心病心绞痛患者1334例,所有患者均仔细询问心绞痛发作病史及经冠状动脉造影(CAG)检查,其中17例患者符合走过心绞痛的诊断,总结其临床特征、记录心电图变化、并根据CAG结果选择进一步治疗方案。结果与临床一般心绞痛相比,走过心绞痛很容易被误诊和漏诊,本次住院前误诊和漏诊率为100%;CAG结果显示冠状动脉单支病变8例,2支病变7例,3支病变2例;所有病例均有明显的侧支循环形成;全部17例患者中13例(76%)需要进一步血运重建,其中9例采取了冠状动脉介入治疗,4例采取了冠状动脉搭桥术;另4例采取了单纯药物保守治疗。结论走过心绞痛患者的心绞痛发作症状极不典型,即活动开始时出现心绞痛的症状,但随着活动的继续,心绞痛症状非但不加重反而逐渐消失,加之心电图未出现典型缺血性变化,因此在临床上极容易被误诊和漏诊;另一方面,此类患者冠状动脉狭窄程度重,冠状动脉侧支循环形成明显,大部分患者需要进一步血运重建。侧支循环与缺血预适应均参与了走过心绞痛的发病机制。
Objective To investigate the clinical characteristics and pathogenesis of a special type of angina pectoris-angina pectoris. Methods A total of 1334 patients with coronary heart disease angina pectoris were observed and recorded. All patients were asked about the history of angina pectoris and the coronary artery angiography (CAG). Seventeen patients were diagnosed with angina pectoris and their clinical features were summarized. The electrocardiographic changes , And according to CAG results choose further treatment options. Results Compared with clinical angina pectoris, angina pectoris was easily misdiagnosed and missed. The misdiagnosis and misdiagnosis rate before hospitalization was 100%. CAG results showed that there were 8 cases with single coronary artery disease, 7 cases with 2 lesions and 3 lesions 2 cases. All the cases had obvious collateral circulation. Thirteen (76%) of 17 patients required further revascularization. Among them, 9 patients underwent coronary artery intervention and 4 patients underwent coronary artery bypass grafting. The other 4 cases took a simple drug conservative treatment. Conclusions The symptoms of angina pectoris in patients with angina pectoris are extremely uncharacteristic, that is, the symptoms of angina appear at the beginning of activity. However, as the activity continues, the symptoms of angina pectoris are gradually diminished and disappear gradually. In addition, the typical ischemic changes do not appear on ECG, Clinically very easy to be misdiagnosed and missed diagnosis; the other hand, such patients with severe coronary stenosis, coronary collateral formation was obvious, most patients need further revascularization. Collateral circulation and ischemic preconditioning are involved in the pathogenesis of angina pectoris.