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1、壁冠状动脉和心肌桥的临床观察【摘要】目的观察分析壁冠状动脉和心肌桥的临床特点。方法观察分析经冠脉造影确诊的48例50处心肌桥患者的临床症状、心电图表现、Holter结果、心肌酶谱、肌钙蛋白T、次极量平板运动试验结果，并对心肌桥、桥前、桥后的造影结果进行分析，随访药物及支架治疗心肌桥的疗效。结果前降支心肌桥的部分心电图表现为V4〜V5/V6导联ST段压低，和(或)T波倒置，发生率48.4%o次极屋平板运动试验阳性者心肌桥的平均狭窄程度重于阴性者。但心电图、次极量平板运动试验、临床症状、Holter结果、心肌晦谱、肌钙蛋白T
2、对心肌桥的诊断均无特界性。造影发现94%的心肌桥发牛.于LAD6〜8。心肌桥前岀现斑块狭窄16处(发生率32%),血液滞留10处(发生率20%),总的发生率52%。而桥后斑块狭窄和血液滞留各仅1例。但桥前在不同情况下(正常、斑块狭窄、血液滞留)，心肌桥的狭窄度差界无显苦性。“恬尔心”和(或)倍他乐克治疗心肌桥总有效率87.8%03例发牛:于LAD7〜8段的心肌桥狭窄在80%以上，均植入了支架，平均随访36.3个月，无1例因胸闷、胸痛而再入院的。结论造影发现“收缩期狭窄”为目前确诊心肌桥的主要方法，桥前易发生斑块狭窄和血液
3、滞留，药物(B受体阻滞剂、钙拮抗剂)和支架对心肌桥具冇一定疗效。【关键词】壁冠状动脉；心肌桥；临床观察ClinicalobservationofintramuralcoronaryarteryandmyocardialbridgeXIANYu-qiong,ZHENGChang-zhu,TANGLan,etal.DepartmentofCardiology,ShanghaiSeventhPeople’sHospital,Shanghai200137,China[Abstract]ObjectiveClinica
4、lcharacteristicsofintramuralcoronaryarteryandmyocardialbridgewereobservedandanalysed・MethodsClinicalsymptoms,electrocardiogram(ECG),Holtermonitor(dynamicECG),myocardialenzyme,troponinTandtreadmilltestwereobservedandanalysedinthatfiftymyocardialbridgesofforty-eigh
5、tpatientsdiagnosedbycoronaryarteryradiography.Radiographyresultsofmyocardialbridge,infrontofthemyocardialbridgeandatthebackofthemyocardialridgewereanalysed,curativeeffectofdrugsandstentonmyocardialbridgewereobserved.ResultsDepressioninSTsegmentand/orinversioninTw
6、aveofV4-V5/V6leadsweredisplayedonECGthatpatientswithmyocardialbridgeinleftanteriordescendingartery(LAD)5therateofhappenis48.4%・Theaveragestenosisofmyocardialbridgeismoreseriousintreadmilltestthatispositivereactionthanthatisnegative.Butitisnotcontributivetodiagnos
7、isofmyocardialbridgethatECG,treadmilltest,clinicalsymptom,Holter,myocardialenzymeandtroponinT・94%ofmyocardialbridgeswerefoundinLAD6-8bycoronaryarteryradiography.Thereweresixteenplaceswherewithspottedstenosisandtenplaceswherebloodflowslowlyinfrontofthemyocardialbr
8、idge,therateofhappenis32%and20%respectively,therateofhappeninallis52%.Buttherewasonlyoneplacewherewithspottedstenosisandbloodflowslowlyatthebackofthemyocardial
