刘国勇,苏晓灵,白明,张钲

• 1:威海市立医院心内科
• 2:青海省人民医院心内科
• 3:兰州大学第一医院心脏中心

摘要(Abstract)：

目的评价急性ST段抬高型心肌梗死(STEMI)合并只有一支主要心外膜急性冠状动脉完全闭塞(ATO)时冠状动脉侧支循环(CCC)的影像学特点。方法收集2016年9月至2018年6月在兰州大学第一医院住院的209例STEMI合并ATO患者和80例冠状动脉慢性完全闭塞(CTO)病变患者,所有患者都只有一支主要心外膜冠状动脉闭塞。根据发病时间将ATO患者分为第1～4组,相应发病时间为≤3 h、3～6 h、6～12 h、12～72 h,CTO患者为第5组,比较5组患者不同闭塞冠状动脉、不同冠状动脉优势型、左前降支是否绕过心尖等不同情况下CCC Rentrop分级的差异,采用Spearman法分析CCC分级与发病时间的相关性。结果 5组患者同侧侧支循环、对侧侧支循环及最终Rentrop分级比较,差异均有统计学意义(均P<0.001);与第5组(CTO患者)相比较,第1组、第2组、第3组及第4组同侧侧支循环及对侧侧支循环Rentrop分级比较,差异均无统计学意义(均P>0.05),但最终Rentrop分级差异有统计学意义(P=0.039)。Spearman相关分析法显示,Rentrop分级水平与闭塞时间相关(r=0.577,P<0.001)。不同闭塞冠状动脉同侧侧支循环Rentrop分级比较,差异无统计学意义(P=0.065);但对侧侧支循环及最终Rentrop分级比较,差异均有统计学意义(均P<0.05)。不同冠状动脉优势及左前降支是否绕过心尖同侧侧支循环、对侧侧支循环及最终Rentrop分级比较,差异均无统计学意义(均P>0.05)。结论对于STEMI合并ATO患者,冠状动脉闭塞时间对CCC的影响较大,闭塞时间越长,Rentrop分级越高;不同闭塞动脉对CCC有较大影响,右冠状动脉闭塞时Rentrop分级最高,左前降支次之,左回旋支最低。

关键词(KeyWords)： ST段抬高型心肌梗死;冠状动脉侧支循环;Rentrop分级

Abstract:

Keywords:

基金项目(Foundation): 青海省科学技术厅基础研究计划项目(2019-ZJ-7039)

作者(Author): 刘国勇,苏晓灵,白明,张钲

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