急性下壁心肌梗死累及右心室的冠状动脉特点及近期预后

目的：研究急性下壁心肌梗死累及右心室者的冠状动脉闭塞部位及近期预后。方法：观察急诊及住院的96例急性下壁心肌梗死患者，其中右心室梗死43例（A组），单纯下壁梗死53例（B组）。结果：A组冠状动脉造影30例，全部为右冠闭塞，近中端闭塞23例，远端7例；B组造影38例，右冠闭塞19例，近中端10例，远端9例，回旋支闭塞19例。A组合并的其它血管病变比B组更严重。A组肌酸磷酸肌酶峰值高于B组，P〈0.01；A组心源性休克发生率20．9％，病死率16．2％，B组均为0例，均P〈0．01。结论：右冠近、中、远端闭塞均可发生右心室梗死；合并右心室梗死者近期预后较单纯下壁梗死者差，其发生心源性休克且常常不可逆的原因为右冠近中端完全闭塞同时还合并有多支血管的严重病变。

Characteristics of coronary artery and short-term prognosis of patients with acute inferior myocardial infarction involving right ventricle

Objective To study the site of coronary artery occlusion and short-term prognosis of patients with acute inferior myocardial infarction involving right ventricle.Methods The short-term prognosis was studied in 96 patients with acute inferior myocardial infarction,in which 43 patients with right ventricular infarction(group A) and 53 patients with simple inferior myocardial infarction(group B).Results Thirty cases in group A underwent coronary angiography and all cases of the occlusion occurred in right coronary artery,in which 23 were proximal or middle segment occlusion,and 7 were distal.Thirty-eight cases in group B underwent coronary angiography,and 19 cases of occlusion occurred in right coronary artery(10 cases were proximal or middle segment occlusion,9 cases were distal) and 19 in circumflex.Group A had more seriously involved other artery injury than group B.CPK peak value,the incidence of cardiogenic shock,and the mortality in group A were higher than group B(P<0.01).Conclusion Proximal,middle,or distal segment right coronary artery occlusion can lead to right ventricular infarction.The short-term prognosis of the patients with right ventricular infarction is worse than that with simple inferior myocardial infarction. The reason why the patients with right ventricular infarction suffer from cardiogenic shock easily and their shock always is irreversible is that proximal or middle segment right coronary artery occlusion is often accompanied by other coronary arteries injury.