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目的以计帧法定量评价心电图有心肌缺血改变而冠状动脉造影正常者的临床意义。方法20例静息心电图或平板运动试验有缺血改变(连续2个及以上相关导联ST段水平型或下斜型下移≥0.05mV或T波深倒置)但冠状动脉造影正常者为缺血组。50例有心绞痛样症状而心电图、平板运动试验及冠状动脉造影正常者为对照组:测定缺血相关性冠状动脉血流计帧值(TIMI-FC)。并用双密达膜(潘生丁)75~150mg/d,口服,治疗冠状动脉血流缓慢者。结果缺血组心电图示前壁心肌缺血者的左冠状动脉的前降支、下壁缺血者的右冠状动脉及高侧壁缺血者的左冠状动脉回旋支血流的TIMI-FC值显著>对照组,分别为(34.2±15.6),(18.7±12.5),P<0.05;(38.1±11.03),(21.3±13.8),P<0.05;及(35.2±15.8),(18.2±12.6),P<0.01;TIMI-FC测定结果以<27为血流正常(normal coronary flow,NCF);≥27为血流缓慢。血流缓慢者(slow coronarny flow,SCF)21例,SCF21例中,潘生丁治疗2周后症状缓解及ST-T改善者14例(70%);SCF中心电图有缺血者15例(71.4%),显著多于NCF中心电图有缺血者5例(11.1%);NCF中心电图正常者44例(88.9%),显著多于SCF中心电图正常者6例(28.6%),P<0.01。结论冠状动脉造影正常而心电图有缺血改变者的相关冠状动脉血流缓慢,提示血流缓慢可作为心肌缺血的指标之一,潘生丁可改善这类患者的症状。
Objective To quantitatively evaluate the clinical significance of myocardial infarction patients with normal coronary angiography by frame counting method. Methods 20 patients with resting electrocardiogram or treadmill exercise test had ischemic changes (two or more consecutive leads of ST-level horizontal or down-tilt ≥ 0.05mV or T-wave deep inversion) but normal coronary angiography was absent Blood group. 50 patients with angina-like symptoms and electrocardiogram, treadmill exercise test and normal coronary angiography as the control group: determination of ischemia-related coronary flow meter frame value (TIMI-FC). And double the membrane (dipyridamole) 75 ~ 150mg / d, oral, treatment of coronary blood flow were slow. Results Electrocardiogram of ischemic group showed TIMI-FC value of left anterior descending coronary artery in anterior wall myocardial ischemia, right coronary artery in inferior wall ischemic and left circumflex coronary flow in patients with high lateral wall ischemia (34.2 ± 15.6), (18.7 ± 12.5), P <0.05; (38.1 ± 11.03), (21.3 ± 13.8), P <0.05; ), P <0.01; TIMI-FC was <27 for normal coronary flow (NCF); ≥27 was for slow blood flow. 21 cases of SCF (slow coronarny flow) and 14 cases (70%) of symptom relieving and ST-T improvement after dipyridamole treatment for 2 weeks in SCF 21 cases; 15 cases (71.4% ) Were significantly higher than NCF ECG in 5 cases (11.1%); NCF electrogram was normal in 44 cases (88.9%), significantly more than SCF ECG in 6 cases (28.6%), P <0.01. Conclusion Coronary angiography is normal and ischemic changes of ECG-related coronary blood flow is slow, suggesting that slow blood flow can be used as an indicator of myocardial ischemia, dipyridamole can improve the symptoms of these patients.