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目的分析变异性心绞痛患者伴发晕厥的相关危险因素。方法 2003年1月至2011年03月期间我院心内科住院患者中诊断变异性心绞痛74例,根据病程中晕厥发作的有无,分为晕厥组(n=16)和非晕厥组(n=58)。对比分析两组患者的危险因素、临床特征和冠状动脉造影结果。结果 (1)与非晕厥组比较,晕厥组患者发作时恶性心律失常发生率较高(10.3%对100%,P<0.0001),空腹血浆低密度脂蛋白胆固醇较低(2.15±0.73mmol/L对1.68±0.45mmol/L,P=0.003),两组患者的心血管危险因素、胸痛特点和入院前使用药物、其他实验室检查指标、左室射血分数、发作时心电图的心脏缺血部位和ST段抬高导联数目并无统计学差异。(2)冠脉造影显示,两组患者的血管病变严重程度无统计学差异;与非晕厥组比较,晕厥组患者中前降支固定性狭窄较少(34.48%对6.25%,P=0.03),而右冠狭窄较多,但未达统计学差异(8.62%对25%,P=0.095)。(3)多因素Logistic回归分析显示恶性心律失常(P<0.0001)和右冠状动脉狭窄(P=0.028)是变异性心绞痛患者发生晕厥的独立危险因素。结论变异性心绞痛患者并发晕厥并非少见,恶性心律失常是晕厥的直接原因。右冠状动脉固定性狭窄的患者容易发生晕厥,需要引起重视并积极干预。
Objective To analyze the related risk factors of syncope in patients with variant angina. Methods From January 2003 to March 2011, 74 patients with diagnosed angina pectoris in our hospital were divided into syncope group (n = 16) and non-syncope group according to the presence or absence of syncope (n = 58). The risk factors, clinical features and results of coronary angiography were compared between the two groups. Results Compared with non-syncope group, the incidence of malignant arrhythmia was higher in patients with syncope (10.3% vs 100%, P <0.0001) and lower fasting plasma LDL cholesterol (2.15 ± 0.73mmol / L (1.68 ± 0.45 mmol / L, P = 0.003). The cardiovascular risk factors, chest pain characteristics, pre-admission medication, other laboratory tests, left ventricular ejection fraction, ischemic sites at the onset of electrocardiogram There was no statistical difference in the number of ST segment elevation leads. (2) Coronary angiography showed no significant difference in the severity of vascular lesions between the two groups. Compared with the non-syncope group, the anterior descending coronary artery stenosis was less in the syncope group (34.48% versus 6.25%, P = 0.03) , While the right coronary stenosis more, but not statistically significant (8.62% vs 25%, P = 0.095). (3) Multivariate logistic regression analysis showed that malignant arrhythmia (P <0.0001) and right coronary artery stenosis (P = 0.028) were independent risk factors for syncope in patients with variant angina. Conclusions Syncope is not uncommon in patients with variant angina and malignant arrhythmia is the direct cause of syncope. Patients with stenosis of the right coronary artery are prone to syncope and need to be valued and actively intervened.