摘要
目的分析冠状动脉造影结果正常的临床诊断为急性冠脉综合征(ACS)患者的病因。方法选取2016年10月—2017年3月第四军医大学西京医院心脏内科重症监护室收治的临床诊断为ACS的患者546例,回顾性分析冠状动脉造影结果正常的临床诊断为ACS患者的病因。结果 546例临床诊断为ACS的患者中冠状动脉造影检查结果有临床意义者454例(占83.2%),正常者92例(占16.8%)。92例冠状动脉造影检查结果正常者中ST段抬高34例(占37.0%),非ST段抬高58例(占63.0%);54例(占58.7%)为冠状动脉痉挛所致心绞痛,20例(占21.7%)为急性病毒性心肌炎,6例为心脏神经症(占6.5%),4例为心肌桥(占4.3%),3例为心肌炎(占3.3%),2例为主动脉夹层(占2.2%),2例为嗜铬细胞瘤(占2.2%),1例为肺栓塞(占1.1%)。结论临床诊断为ACS但冠状动脉造影结果正常者以冠状动脉痉挛所致心绞痛、急性病毒性心肌炎等为主,临床应结合心肌酶谱变化、溶栓后血管再通情况及心电图变化等进一步有计划地完善相关检查,以明确诊断和指导临床合理治疗。
Objective To analyze the etiological factors in patients clinically diagnosed as acute coronary syndrome presenting normal coronary angiography examination results.Methods From October2016to March2017,a total of546patients clinically diagnosed as acute coronary syndrome were selected in the Cardiac Intensive Care Unit,Xijing Hospital of the Fourth Military Medical University,the etiological factors in patients presenting normal coronary angiography examination results were retrospectively analyzed.Results Of the546patients clinically diagnosed as acute coronary syndrome,454cases found positive coronary angiography examination results with clinical significance(accounting for83.2%);92cases found normal coronary angiography examination results(accounting for16.8%),including34cases with ST-segment elevation(accounting for37.0%)and58cases with non ST-segment elevation(accounting for63.0%),54cases with coronary artery spasminduced angina pectoris(accounting for58.7%),20cases with acute viral myocarditis(accounting for21.7%),6cases with cardiac neurosis(accounting for6.5%),4cases with myocardial bridge(accounting for4.3%),3cases with myocarditis(accounting for3.3%),2cases with aortic dissection(accounting for2.2%),2cases with pheochromocytoma(accounting for2.2%),1case with pulmonary embolism(accounting for1.1%).Conclusion Patients clinically diagnosed as acute coronary syndrome presenting normal coronary angiography examination results mainly are coronary artery spasm-induced angina pectoris,acute viral myocarditis and so on,clinicians should systematically carry out relevant examinations according to the changes of myocardial enzyme,vascular recanalization after thrombolytic therapy,to confirm the diagnosis and guide clinical rational treatment.
作者
马网霞
李家一
MA Wang-xia;LI Jia-yi(Department of Cardiology,the People's Hospital of Zhouzhi County,Xi'an 710400,China;Department of Cardiology,Xijing Hospital of the Fourth Military Medical University,Xi'an 710032,China)
出处
《实用心脑肺血管病杂志》
2018年第1期92-94,共3页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
关键词
急性冠脉综合征
心肌炎
冠状血管造影术
诊断
鉴别
Acute coronary syndrome
Myocarditis
Coronary angiography
Diagnosis,differential
