严重冠状动脉痉挛患者的临床特点分析及治疗随访

目的总结严重冠状动脉痉挛患者的临床特点，治疗方法及随访预后情况。方法选择确诊为冠状动脉痉挛的患者21例。了解患者的一般情况，包括年龄、性别、基础疾病、吸烟史及用药等，分析其临床特点、心电图、冠状动脉造影资料、诊断治疗及随访预后情况。结果严重冠状动脉痉挛患者以男性多见，占86％（18／21）；吸烟是主要的危险因素，占62％（13／21）；痉挛多发生于有固定狭窄的部位，占57％（12／21），临床经过凶险，及时冠状动脉造影对早期明确诊断至关重要。钙离子拮抗剂是有效治疗的核心，其使用强调持续、足量，介入治疗不是有效的方法。冠状动脉痉挛急性发作期具有极高的危险性，但长期预后良好。结论冠状动脉痉挛临床常见，但易被忽视，及时诊断是防止致命事件的关键，钙离子拮抗剂是冠状动脉痉挛的核心用药，远期预后良好。

Clinical features,treatment and follow-up of patients with severe coronary artery spasm

Objective To summarize the clinical features, treatment and follow-up of patients with severe coronary artery spasm. Methods Twenty-one patients with confirmed coronary artery spasm were selected. The study reviewed the patients＇ general conditions including age, gender, complication, smoking and drug situations. The clinical features, electrocardiogram and coronary angiography data were analyzed. Their diagnosis, treatment and prognosis were evaluated. Results Male （ 86%, 18/21 ） had higher incidence in severe coronary artery spasm. Smoking （62%, 13/21 ） was a major risk factor. Coronary artery spasm often happened on the base of a fixed narrow （57%, 12/21 ）,and the clinical process was treacherous. Coronary angiography was very important for early diagnosis. Calcium antagonist was the core of the treatments and should be sustained at full dose. Interventional therapy was not efficacious. Although patients in acute phase had higher risk,long-term prognosis was good. Conclusions Coronary artery spasm is a common problem, but it is often overlooked. Timely diagnosis is the key to prevent fatal events. Calcium antagonist is the core of the coronary artery spasm drugs. The long-term prognosis of coronary artery spasm is good.