缺血预处理对急性心肌梗塞患者晚期溶栓治疗效果的影响

Effects of ischemia preconditioning on acute myocardial infarction with late thrombolytic therapy

目的：探讨缺血预处理对急性心肌梗塞患者晚期溶栓治疗效果的影响。方法：９２例患者按梗塞前心绞痛病史不同分为远期预处理组（Ａ组，３３例）、近期预处理组（Ｂ组，３０例）和无预处理组（Ｃ组，２９例），均于胸痛后６～１２小时内行静脉溶栓治疗。观察冠脉再通率、心肌梗塞范围、心律失常发生率及病死率。结果：Ｂ组冠脉再通率（５６．７％）大于Ａ组（３０．３％）和Ｃ组（１３．８％），Ｐ均＜０．０５；Ｂ组和Ａ组晚期再灌注可减少心肌梗塞范围（Ｐ均＜０．０５）；Ｂ组心律失常发生率（１３．３％）也小于Ａ组（４５．５％）和Ｃ组（４８．３％），Ｐ均＜０．０５；Ｃ组冠脉再通者病死率（５０．０％）显著增高（Ｐ均＜０．０５）。结论：缺血预处理对急性心肌梗塞患者晚期再灌注能减少心肌梗塞范围；只有近期预处理能提高冠脉再通率和减少心律失常；无预处理者晚期再灌注甚至可增加病死率。

Objective:To observe effects of ischemia preconditioning on acute myocardial infarction with late thrombolytic therapy.Methods:Ninetytwo patients with acute myocardial infarction were divided into three groups according to preinfarction angina.They were remote preconditioning group (group A,n=33),recent preconditioning group(group B,n=30) and no preconditioning group (group C,n=29).All patients received intravenous thrombolysis within 6￣12 hours after angina.The incidence of late reperfusion,the size of myocardial infarction,the incidence of arrhythmia and mortality were observed.Results:The incidence of late reperfusion in group B(56 7%) was higher than that in group A (30 3%) and group C(13 8%)(all P <0 05).In patients with or without reperfusion,the size of myocardial infarction in group B and group A was reduced (all P <0 05).In addition,the incidence of arrhythmia in group B(13 3%) was significantly lower compared with both group A(45 5%) and group C(48 3%) (all P <0 05).After reperfusion,however,the mortality of reperfusion patients in group C was higher than that in no reperfusion patients and that in group A and group B(all P <0 05).Conclusions:These data suggest that ischemia preconditioning may reduce the size of myocardial infarction after late reperfusion.But only recent preconditioning can increase the incidence of late reperfusion and decrease the incidence of arrhythmia.Without preconditioning,it seems that late reperfusion increases mortality in patients with acute myocardial infarction.