不稳定性心绞痛冠状动脉造影和血运重建的可行性探讨

目的研究不稳定性心绞痛的临床及介入心脏病学诊疗，并探讨其诊疗指引。方法分析包括初发型、恶化型、卧位型、变异型、中间综合征共63例不稳定性心绞痛患者的临床介入心脏病学诊疗资料，患者均行选择性冠状动脉造影。结果37例患者冠状动脉造影显示冠脉狭窄，占58.7％，其中70.3％狭窄程度大于50％，43.8％为多支冠脉狭窄。年龄、性别、病程、血脂在冠脉狭窄与非狭窄患者之间的差别无统计意义，但伴高血糖或高血压的患者冠脉狭窄发生率明显高于不伴高血糖或高血压患者。另冠脉狭窄中67.5％患者24小时动态心电图示ST下移≥0.2mV。26例冠脉狭窄大于50％的患者作了介入治疗后心绞痛消失。结论不稳定性心绞痛尤其伴高血压、高血糖或24小时动态心电图ST下移≥0.2mV患者多数有冠脉器质性狭窄，甚至为多支冠脉狭窄，其次不稳定性心绞痛易发生急性心肌梗死或猝死的潜在的病理解剖基础，应尽早行冠脉造影以便进一步治疗，必要时行介入治疗，三支病变拟行冠状动脉旁路移植术。

Research of clinical and percutaneous medical cardiology of unstable angina pectoris

Objective To study the relation between clinical and percutaneous medical cardiology of unstable Angina pectoris (UAP) and investigate the medical guidance of UAP Methods The data including clinical and selective coronary angiography of all 63 patients with UAP including incipient (nascent) angina, exacerbation angina, nocturnal angina, Prinzmental's angina, intermediate syndrom were studied Results 37 patients whose coronary angiography showed coronary stenosis were 58 7 percent of all patients In the 70 3 percent of the 37 patients coronary stenosis degree was more than 50 percent, and 43 8 percent of the patients had more than twovessels stenosis There was no statistical significance between patients with coronary stenosis and patients without coronary stenosis in age, sex, ill period, blood lipid The prevalence of coronary organic stenosis in the UAP patients with high blood glucose and hypertension was significantly higher than that with normal blood glucose and normotensive And Holter monitoring in 67 5 percent with coronary stenosis showed that depression of the ST segment is more than 0 20 mv The prevalence of coronary stenosis of exacerbation angina, nocturnal angina, Prizmental's angina, intermediate syndrom was respectively 57 14%, 57 14%, 75% and 100% After coronary angioplasty, in 26 patients whose stenosis degree was more than 50%, chest pain eliminated Conclusion Patients with UAP mostly have coronary organic stenosis, so as far to more than two stenosis vessels, espeacially with hypertension, high blood glucose or depression of the ST segment more than 0 2mv in Holter monitoring It is potentiol pathological essential reason that patients with UAP are liable to have acute myocardiol infarction or heart arrest It is advisable that patients with UAP should have coronary angiography as soon as possible Sometimes coronary angioplasty is necessary