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[1]王砚青,叶飞,赵艳芳,等.自发性冠状动脉壁内血肿致急性心肌梗死诊疗分析[J].医学研究与战创伤救治(原医学研究生学报),2019,21(3):258-261.[doi:10.3969/j.issn.1672-271X.2019.03.008]
　WANG Yan-qing,YE Fei,ZHAO Yan-fang,et al.Diagnosis and treatment of acute myocardial infarction caused by spontaneous coronary intramural hematoma[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2019,21(3):258-261.[doi:10.3969/j.issn.1672-271X.2019.03.008]
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自发性冠状动脉壁内血肿致急性心肌梗死诊疗分析()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第21卷
期数:
2019年3期
页码:
258-261
栏目:
出版日期:
2019-05-10

文章信息/Info

Title:
Diagnosis and treatment of acute myocardial infarction caused by spontaneous coronary intramural hematoma
文章编号:
1672-271X（2019）03-0258-04
作者:
王砚青;  叶飞;  赵艳芳;  尤威;  吴志明;  陈群;  徐彧
作者单位：210002 南京，东部战区总医院（原八一医院）心内科（王砚青、赵艳芳、陈 群、徐 彧）; 210006 南京，南京医科大学附属南京医院(南京市第一医院)心内科（叶 飞、尤 威、吴志明）
Author(s):
WANG Yan-qing1;  YE Fei2;  ZHAO Yan-fang1;  YOU Wei2;  WU Zhi-ming2;  CHEN Qun1;  XU Yu1
(1.Department of Cardiology，General Hospital of Eastern Theater Command，PLA，Nangjing 210002，Jiangsu，China; 2.Department of Cardiology，Nanjing Hospital Affiliated to Nanjing Medical University，Nanjing 210006，Jiangsu，China)
关键词:
自发性冠状动脉壁内血肿;  急性心肌梗死;  血管内超声;  经皮冠状动脉介入治疗
Keywords:
spontaneous coronary intramural hematoma;  acute myocardial infarction;  intravascular ultrasound;  percutaneous coronary intervention
分类号:
R543.3
DOI:
10.3969/j.issn.1672-271X.2019.03.008
文献标志码:
A
摘要:
目的 分析自发性冠状动脉壁内血肿（SCIMH）致急性心肌梗死患者临床资料，探讨诊疗方案。 方法 回顾性分析2015年4月至2017年7月双中心临床诊断为急性心肌梗死的2027例患者影像学资料，依靠血管内超声（IVUS）或光学相干断层扫描（OCT）共检出33例急性心肌梗死为冠状动脉壁内血肿所致，分析其病变特点、诊疗方案和临床转归。 结果 33例SCIMH患者中，29例（87.9%）表现为典型胸痛症状。所有患者血清肌酸激酶同工酶及肌钙蛋白I均升高，分别为（21.86±5.12）ng/mL、（7.38±6.67）ng/mL。45%的患者心电图表现为非ST段抬高型心肌梗死，21%为急性下壁心肌梗死。33例患者共发现37处血肿，主要分布于左前降支近段（19%）、中远段（35%）及右冠状动脉中远段（22%），70%的血肿TIMI血流分级为Ⅲ级。2例（6%）予冠脉支架植入，31例（94%）行药物保守治疗。随访过程中，1例（3.0%）因血肿进展予支架植入，2例（6.1%）血肿较前吸收，2例（6.1%）血肿完全吸收。所有患者均未发生心血管不良事件。 结论 IVUS及OCT是自发性冠状动脉壁内血肿可靠的早期诊断方法，血流动力学稳定的自发性冠状动脉壁内血肿患者予药物治疗是安全有效的治疗方法。早期诊断与合理药物治疗是改善预后的关键。
Abstract:
Objective To analyze the clinical data of patients with acute myocardial infarction caused by spontaneous coronary intramural hematoma (SCIMH)，and to explore the strategy of diagnosis and treatment. Methods This retrospective study was performed based on imaging data of 2027 patients with acute myocardial infarction diagnosed in the two-center clinical trial from April 2015 to July 2017. A total of 33 patients with acute myocardial infarction were caused by intracoronary hematoma, diagnosed with intravascular ultrasound (IVUS) or optical coherence tomography (OCT). Their clinical characteristics, treatment strategies and outcomes were analyzed. Results Among 33 patients with SCIMH, 29 (87.9%) patients showed typical chest pain symptoms. All 33 patients had elevated serum creatine kinase isoenzyme and troponin I, (21.86±5.12) ng/mL and (7.38 ± 6.67) ng/mL, respectively. In 45% patients, the electrocardiogram showed non-ST-segment elevation myocardial infarction. 21% patients were acute inferior myocardial infarction. A total of 37 hematomas were found in all 33 patients, mainly in the proximal left anterior descending artery (19%), the middle and distal segments (35%), and the distal segment of the right coronary artery (22%). Grade III TIMI blood flow was found in 70% of the hematoma. Among the patients, 2 cases (6%) underwent coronary stent implantation, and 31 cases (94%) underwent conservative drug therapy. During follow-up, 1 patient (3.0%) underwent stent implantation due to hematoma progression, 2 cases (6.1%) had hematoma absorbed partly, and another 2 paitents (6.1%) had complete hematoma absorbed. No cardiovascular adverse events occurred in all patients. Conclusion IVUS and OCT are reliable early diagnostic methods for spontaneous intracoronary intrahepatic hematoma. For SCIMH with stable hemodynamy, conservative drug therapy is safe and efficient. Early diagnosis and rational drug treatment are the key ways to improve prognosis of coronary intramural hematoma.

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备注/Memo

备注/Memo:
收稿日期：2018-08-24
更新日期/Last Update: 2019-05-10