变异性心绞痛ST段抬高的形态与预后关系探讨[J].docVIP

变异性心绞痛ST段抬高的形态与预后关系探讨 李小珠1，黎文英1，邝丽1，陈恩1，肖慧敏1 (湛江中心人民医院，广东湛江524037) [摘要] 目的：探讨变异性心绞痛ST段抬高的形态与预后关系。方法：回顾性分析16例确诊为变异性心绞痛患者的24h动态心电图（DCG）监测结果及临床资料，比较发作时ST一T改变导联（缺血部位）、形态、持续时间，以及发作时的心律失常、猝死前的心电图特点等。结果：（1）多部位病变者恶性心律失常发生率明显增高(P0.05)；（2）ST段抬高≥4mm者恶性心律失常发生率较ST段抬高4mm者明显增高(P0.05)；（3）“巨R型”ST段抬高及缺血性J波者恶性心律失常明显增多(P0.05)；（4）猝死病例全部出现于ST段抬高≥4mm及“巨R型”ST段抬高和缺血性J波者。结论：ST段抬高≥4mm或“巨R型”ST段抬高及缺血性J波，尤其是近一周内VA频繁发作者是预后不良的重要指标，极易发生恶性心律失常以至猝死。强烈提示临床应对这类患者提高警惕，给予及时积极的治疗。 [关健词] 变异性心纹痛 冠状动脉痉挛 心律失常 “巨R型”ST段抬高 缺血性J波 中图分类号:R541.4 文献标识码:B The study of the relationship between the characteristie of ST—segment elevation and prognosis in patients with variant angina pectoris.Li xiaozhu,kuang li,Chen en,Xiao huimin,Central People’s Hospital of Zhanjiang, Guangdong. 524300 【Abstract] Objective To investigate the relationship between the characteristie of ST—segment elevation and prognosis in patients with variant angina pectoris.Methods:Review and analyze the monitoring results and clinical data of dynamic electrocardiogram for 24 hours on 16 cases diagnosed as variant angina pectoris.Results:(1)The insidence of malignant arrhythmia in patients with multi一position lesions was obviously increased than that of one—position lesions(p0.05);(2)The incidence of malignant arrhythmia in patients with ST elevation≥4mm was higher than that of 4mm.(p0.05);(3)The incidence of malignant arrhythmia in patients with”giant R wave“type ST-segment elevation and ischemic J wave was obviously increased(p0.05);(4)the sudden deaths accurred in patients with ST elevation≥4mm and ”giant R wave“type ST-segment elevation and ischemic J wave．Conclusions：The ST elevation≥4mm with unidirectional curve ST一T change or the ”giant R wave“type ST-segment elevation and ischemic J wave is convex sign a bad prognosis. A sudden death and malignant arrhythmia was easily occurred in these patients；Apromptly therapy should be do in them. 【Key words】variant angina pectoris，coronary artery spasm，arrhythmia ，”gi