100例平板试验阳性患者造影结果分析及其临床意义

时间: 2017-09-13 13:00:03 来源:未知 作者:admin 点击:65 次
  

【关键词】  TET;CAG;冠心病

  [摘 要] 目的:为了进一步明确诊断冠心病及冠状动脉病变的部位及程度,对冠心病及可疑冠心病患者分别进行运动试验和冠状动脉造影(CAG),以评估二者之间的相关性。方法:选择运动试验阳性患者100例与CAG情况进行分析比较以便提高临床诊断符合率。结果:有典型的心绞痛,平板试验(TET)阳性与CAG阳性符合率较高;不典型的心绞痛和冠心病危险因素,活动TET与CAG阳性符合率较低。运动试验阳性中,ST段呈水平型或下斜型压低,CAG阳性率高;冠状动脉分支病变,运动试验中出现ST段压低持续时间长,导联数多,两者均多于冠状动脉单支病变。合并高血压或糖尿病患者,运动试验中出现ST段下移的时间早,持续的时间长,与单纯性冠状动脉病变差异有显著的意义。结论:TET阳性患者与冠状动脉病变的关系密切。对冠心病的诊断有较高的敏感性和特异性。

  [关键词] TET;CAG;冠心病

  100 Positive Patients of Treadmill Exercise Test and the Analysis of the Results of Coronary Diseases and Their Clinical Significance

  Abstract:Objective In order to diagnose coronary heart and artery diseases more accurately,and to do exercise test and coronary angiography (CAG) on patients and suspect patients of coronary diseases so as to evaluate the relationship between them.Methods Choose 100 positive patients of exercise test and compare them with the cases of coronary angiography (CAG)so as to raise the rate of conformity in clinical diagnoses.Results With typical angina pectoris,there's a higher conformity rate of positive treadmill exercise test (TET) and positive coronary angiography (CAG).Without typical angina pectoris and dangerous factors of coronary heart diseases,the conformity rate of treadmill exercise test (TET) and positive coronary angiography (CAG) is lower.In positive exercise test,ST segment depresses in horizontal or in slope.The positive rate of coronary angiography (CAG) is high.If there are diseases in some branches of coronary artery,the ST segment depression time becomes long and there are more leads.Both are more than in the case of one branch of coronary artery diseases.Consider patients with high blood pressure or diabetes,the depression time of ST segment in exercise tests comes early and it lasts olng.This is completely different from that of pure coronary artery diseases.Conclusion The positive patients of treadmill exercise test (TET) are closely related to diseases of coronary artery.And it has higher sensitivity and specificity in diagnosing coronary artery diseases.

  Key words:TET;CAG;Coronary heart disease

  活动平板运动试验(TET)已经广泛地应用于冠心病的诊断,预后以及劳动耐量的评价,其敏感性和预测的准确性均可达到75%[1],本文将总结2004年我院对冠心病患者及可疑冠心病患者分别进行TET及冠状动脉造影(CAG),并选择100例TET阳性患者以及CAG情况进行分析总结,以便进一步评估TET阳性和CAG情况之间的相关性,进一步指导临床、协助诊断冠心病。

  1 资料和方法

  1.1 对象                      

  100例活动平板阳性患者中,其中50例患者有典型的心绞痛症状,30例有不典型的胸疼、胸闷症状,20例有冠心病的危险因素。为了排除冠心病或明确冠状动脉病变的程度,部位而行CAG,其中男性75例,女性25例,年龄29岁~72岁,平均年龄(50.5±6.0)岁。

  1.2 方法及判断标准                      

  CAG采用1 250 mA的X线机,经股动脉Judkin法造影并多体位投照,以通用直径法估测右冠状动脉、左冠状动脉或其他主要分支腔内直径≥75%为阳性。平板运动试验:运动量根据Bruce方案和改良Bruce方案,分别于运动前、中、后8 min内连续同步监测体表12导联心电图,运动终止的指标:运动中出现典型心绞痛症状。运动中出现典型STT改变。心率达到次极量或极量时心率。运动中血压和心率反常变化或不能坚持运动。指标测量:ST段压低的时间(运动开始至ST段在原有水平上呈现缺血型压低>0.1 mV的时间)。ST段压低持续时间(ST段开始压低至ST段恢复到运动前水平的时间)。ST段压低程度(ST段在原有水平上压低的幅度)。运动试验阳性指标:运动中或运动后R波为主的导联J点后80 ms处的ST段在原有水平上出现缺血性或近似缺血性压低0.1 mV以上且持续2 min以上。

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