学术论文

      变异型心绞痛并发严重心律失常的临床疗效观察

      Observation on curative effect in patients with variant angina complicating severe arrhythmia

      摘要:
      目的分析变异型心绞痛并发严重心律失常的类型,并比较不同处理方法的治疗效果。方法纳入2010年1月~2012年3月变异型心绞痛合并严重心律失常患者34例,记录分析心绞痛发作时及发作后的心电图。随访(12~24)个月,定期复查12导联心电图和(或)Holter,总结不同治疗方案的疗效。结果所有患者均接受抗冠脉痉挛药物治疗,其中20例(58.8%,20/34)存在血管严重狭窄,18例行经皮冠状动脉内支架置入术,2例行冠状动脉旁路移植术(其中1例术后出现严重心动过缓,予置入永久起搏器);14例冠脉造影结果无异常或轻度异常的患者中1例并发三房室传导阻滞置入永久起搏器,1例伴室性心动过速和晕厥,置入心腔内心脏除颤器(ICD),余仅接受药物治疗。随访期间共2例失访,1例5个月时无法取得联系,另1例7个月时院外猝死,随访率94.1%,余32例患者分别于治疗后定期复查12导联心电图和(或)Holter,未见严重心律失常、心悸及晕厥。结论通过选择合理治疗方案,变异型心绞痛并发的严重心律失常可得到有效控制。
      Abstract:
      Objective To analyze the types of variant angina complicating severe arrhythmia, and compare the curative effects of different treatment methods. Methods The patients (n=34) with variant angina complicating severe arrhythmia were chosen from Jan. 2010 to Mar. 2012, and their ECG were recorded and analyzed during the attack of angina and after the attack. After following up for 12 to 24 months, 12-lead ECG and/or Holter were reviewed periodically and the curative effects of different treatment plans were summed up. Results Total 34 patients accepted the treatment of anti-coronary-spasm drugs, of them 20 (58.8%) had severe vascular stenosis, 18 accepted PCI, 2 had coronary artery bypass grafting (CABG, one case with permanent pacemaker because of severe bradyarrhythmia), 1 of 14 with normal or mild abnormal coronary angiography (CAG) complicatingⅢ° atrioventricular block had implanted permanent pacemaker, 1 with ventricular tachycardia and syncope was implanted ICD, and others were treated with drugs. During the follow-up period, there were 2 cases missed, 1 lost contact on the 5th month and 1 died on the 7th month. The follow-up rate was 94.1%. The remained 32 patients were given 12-lead ECG and/or Holter periodically after the treatment and no severe arrhythmia, palpitation and syncope were observed. Conclusion Through selecting reasonable treatment plans, variant angina complicating severe arrhythmia can be controlled effectively.
      Author: XU Cheng-sheng JIN Zhao-xia LI Huo-ping WANG Zhi-fang
      作者单位: 黄冈市中心医院心血管内科, 黄冈,438000
      年,卷(期): 2013, (4)
      分类号: R541.7
      机标分类号: R54 R5
      在线出版日期: 2013年9月23日