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目的探讨变异型心绞痛(variant angina pectoris,VAP)患者痉挛靶血管部位的判断及其与心律失常的关系。方法回顾性分析160例VAP患者的临床资料,根据VAP发作时心电图ST-T抬高的导联部位,判断相对应的痉挛靶血管,统计VAP发作时不同痉挛靶血管心律失常检出率,心律失常发生机制及VAP性晕厥发生情况。结果 160例VAP患者中左冠状动脉痉挛型94例(58.75%)[其中左前降支88例(55.00%),左回旋支2例(1.25%),左主干4例(2.50%)],右冠状动脉痉挛型46例(28.75%),多支冠状动脉痉挛型20例(12.50%);VAP发作时检出心律失常86例(53.75%),左前降支痉挛心律失常检出率(42.05%)低于右冠状动脉痉挛(65.22%)(P<0.05),其中室性心律失常检出率(27.27%)高于右冠状动脉痉挛(10.87%),缓慢性心律失常检出率(5.68%)低于右冠状动脉痉挛(47.83%)(P<0.05);86例心律失常患者中,缺血性心律失常比率(76.74%)高于再灌注性心律失常(16.30%)和双期性心律失常(6.96%)(P<0.05);左前降支缺血性心律失常比率(67.57%)低于右冠状动脉(90.00%),再灌注性心律失常比率(27.02%)高于右冠状动脉(3.33%)(P<0.05);VAP发作时,23例(14.38%)发生VAP性晕厥,其中左前降支5例(21.74%)、左主干4例(17.39%)、右冠状动脉10例(43.48%)、多支冠状动脉4例(17.39%),左前降支VAP性晕厥比率低于右冠状动脉(P<0.05)。结论 VAP患者痉挛靶血管主要为左前降支,其次为右冠状动脉;VAP发作时心律失常主要由靶血管痉挛致心肌缺血引起;左前降支痉挛易引起室性心律失常,右冠状动脉痉挛易引起缓慢性心律失常;VAP发作时发生VAP性晕厥的主要原因是右冠状动脉痉挛所致的缓慢性心律失常。
Objective To investigate the judgment of the vascular target site of spasm in patients with variant angina pectoris (VAP) and its relationship with arrhythmia. Methods The clinical data of 160 patients with VAP were retrospectively analyzed. According to the lead position of ST-T elevation induced by VAP, the corresponding vasospasm target vessel was determined. The detection rate of vasodial arrhythmia and vas deference Mechanism of abnormalities and occurrence of VAP syncope. Results There were 94 cases (58.75%) of left coronary artery spasm in 160 patients with VAP [including 88 cases (55.00%) in the left anterior descending artery, 2 cases (1.25%) in the left circumflex coronary artery and 4 cases (2.50% Coronary artery spasm in 46 cases (28.75%), multivessel coronary artery spasm in 20 cases (12.50%), VAP attack in the detection of arrhythmia in 86 cases (53.75%), left anterior descending branch spasm arrhythmia detection rate (42.05% ) Was lower than that of right coronary artery (65.22%) (P <0.05). The detection rate of ventricular arrhythmia (27.27%) was higher than that of right coronary artery (10.87%), and the rate of bradyarrhythmia was 5.68% ) Was lower than that of right coronary artery (47.83%) (P <0.05). Among the 86 patients with arrhythmia, the rate of ischemic arrhythmia (76.74%) was higher than that of reperfusion arrhythmia (16.30% The percentage of ischemic arrhythmia (67.57%) in the left anterior descending artery was lower than that in the right coronary artery (90.00%), and the rate of reperfusion arrhythmia (27.02%) was higher than that in the right coronary artery VAP syncope occurred in 23 cases (14.38%) in VAP attack, including 5 cases (21.74%) of left anterior descending artery, 4 cases of left main trunk (17.39%) and 10 cases of right coronary artery 43.48%), multiple coronary arteries in 4 cases (17.39%), left anterior descending artery VAP syncope rate In the right coronary artery (P <0.05). Conclusions The target vessel of spasm in VAP patients is mainly left anterior descending artery, followed by right coronary artery. Arrhythmia caused by VAP is mainly caused by myocardial ischemia caused by target vasospasm. Spasm of left anterior descending artery can cause ventricular arrhythmia easily and right coronary artery spasm is easy. Causing arrhythmia; VAP onset of VAP syncope mainly due to right coronary artery spasm-induced bradyarrhythmias.