冠状动脉侧支循环及其临床意义

目的研究冠状动脉侧支循环开放的条件、影响因素及其对心肌缺血、心功能的保护作用。方法回顾性分析１６３例经冠状动脉造影证实管腔直径狭窄≥７５％的２１４支血管的侧支循环开放情况。结果７９支见侧支循环开放，６３例７２支完全闭塞血管中，３１例３８支侧支循环发展良好（Ａ组），３２例３４支侧支循环发展不良（Ｂ组）。心肌缺血病程长、无高血压病或糖尿病史及右冠状动脉闭塞者，侧支循环发展良好率高。心功能指标Ａ组明显优于Ｂ组，运动负荷试验阴性率两组间无差异。结论侧支循环开放依赖冠状血管完全闭塞或次全闭塞，发展受多种因素影响，良好的侧支循环对缺血心肌和心功能有保护作用，但多数不能消除负荷所致心肌缺血。

Coronary collateral circulation and its clinical significance

Objective The purpose of this study was to assess the condition for and the factors influencing the development of coronary collateral circulation,and its protective effect on the myocardium and heart func tion Methods Coronary angiograms from 163 patients showing 214 coronary arteries with a percent stenosis (75% were retrospectively analyzed for coronary collaterals assessment63 patients (72 arteries) presented with totally occluded coronary arteries; 31 of them (38 arteries) had welldeveloped collateral vessels (Group A); the remaining 32 patients (34 arteries) had poor collateral circulation (group B) Results Angiographica lly detectable collaterals were present in 70 of 72 totally occluded arteries and in 9 of 22 arteries with subtotal occlusion (99% stenosis)Patients with a long history of myocardial ischemia,right coronary occlusion,or without hypertension or diabetes mellitus had a higher incidence of welldeveloped collateral vesselsHeart function parameters were better in Group A compared to The treadmill test result was not significantly different between the two groups Conclusion Coronary collaterals develop in patients with completely occluded or severely stenotic (subtotal occlusion) arteriesTheir development is influenced by a variety of factorsCollaterals can protect ischemic myocardium and preserve left ventricular function,but in most cases can not prevent exerciseinduced ischemia