一、历史回顾自从1845年 Latham 首先提出心肌缺血可因冠状动脉(简称冠脉)痉挛引起以来,近百年来一直有不同意见。支持者的根据:(1)动物实验证实,一过性冠脉(指分布于心肌表面的冠脉主支)狭窄可以引起心电图缺血改变,认为心肌缺血的发生中冠脉管腔的变化比心肌对氧的需求增加更重要;(2)动物实验发现,单独向冠脉注入凝血质,不容易引起心肌缺血坏死,如同时注入垂体后叶素则很容易发生;(3)长期职业接触硝酸盐者,脱离接触后可发生心肌缺血;(4)部分以麦角胺治疗偏头痛的患者可并发胸痛或心电图出现缺血性改变;(5)雷诺氏现象患者可以并发胸痛及 A historical review Since Latham first proposed in 1845 myocardial ischemia can be due to coronary artery (referred to as coronary spasm) has been, for nearly a hundred years have been different views. Supporters of the basis: (1) animal experiments confirmed that a transient coronary artery (refers to the distribution of the main coronary artery surface) myocardial stenosis can cause ischemic changes in the view that the occurrence of myocardial ischemia in the coronary lumen changes (2) animal experiments found that coronary artery into the coagulation alone, not easy to cause myocardial necrosis, such as simultaneous injection of vasopressin is very easy to occur; (3) long-term occupation Contact with nitrates, myocardial ischemia can occur after disconnection; (4) part of ergotamine migraine patients with chest pain or ECG may have ischemic changes; (5) Raynaud’s phenomenon in patients with chest pain and