冠脉微循环障碍合并冠脉痉挛所致急性心肌梗死1例

1 Case of Coronary Microvascular Dysfunction Combined with Coronary Spasm Caused Acute Myocardial Infarction

摘要: 冠状动脉微循环在调节冠状动脉血流量及心肌灌注中起重要作用，其调节机制的异常通常称之为冠状动脉微循环功能障碍，是导致缺血性心脏病的基础性病理生理问题之一，同时也是影响急性ST段抬高型心肌梗死患者再灌注治疗预后的重要因素。冠脉痉挛是影响冠状动脉供血的重要原因，冠脉持续性痉挛会损伤冠脉血管内皮细胞，引发血小板聚集，导致原位血栓形成。冠脉微循环功能障碍合并冠脉痉挛导致急性心肌梗死的病例在文献中报道较少，本文报道的是一位69岁的男性患者，因突发胸痛、胸闷伴晕厥4小时入院，诊断为急性ST段抬高型心肌梗死，立即行冠状动脉造影 + IVUS检查，患者右冠狭窄60%，排空迟缓，右冠近段偏心斑块，斑块负荷61%，给予患者抗血小板、抗凝、控制血压血糖、控制心室率、营养心肌、改善心室重构以及对症支持等治疗，加用尼可地尔、复方丹参滴丸、地尔硫卓改善患者微循环及冠状动脉痉挛后，患者未再诉胸闷、胸痛等不适。

Abstract: Coronary microcirculation in regulation of coronary blood flow and myocardial perfusion plays an important role, and its regulating mechanism of abnormal, often called coronary microcirculation dysfunction is one of the basic pathological and physiological problems lead to ischemic heart disease, also affect patients with acute STEMI are the important factors of prognosis of reperfusion therapy. Coronary spasm is an important factor affecting the blood supply of coronary arteries. Continuous coronary spasm will damage the endothelial cells of coronary arteries, cause platelet aggregation, and lead to in situ thrombosis. Coronary microcirculation dysfunction merger results in acute myocardial infarction in coronary spasm of cases reported in the literature is less. This article reports a 69-year-old male patient, due to the sudden chest pain, chest tightness with syncope 4 hours, diagnosed with acute STEMI in hospital, coronary angiography + IVUS examination immediately. Inspection results show right coronary stenosis was 60%, emptying slowly, right in eccentric plaques, plaque load 61%, giving patients antiplatelet and anticoagulant, control blood sugar and blood pressure, control of ventricular rate, myocardial nutrition, improve ventricular remodeling and symptomatic treatment. After add Nicordil, compound Danshen dropping pills and Diltiazem to improve the patient’s microcirculation and coronary artery spasm, the patient did not complain chest tightness, chest pain and other discomfort.