心肌缺血预适应对溶栓治疗的急性心肌梗死患者近期及远期预后的影响

An evaluation of effects of ischemic preconditioning on short- and long-term outcomes in the treatment of acute myocardial infarction by thrombolysis

目的探讨心肌缺血预适应（IPC）对急性心肌梗死（AMI）溶栓治疗患者近期及远期预的影响。方法选取152例进行静脉溶栓治疗的首次ST段抬高的急性心肌梗死住院患者，根据AMI发病前24h内是否有IPC分为有IPC组（A组，n=80）和无IPC组（B组，n=72）两组一般临床资料差异无统计学意义（P〉0．05），回顾性分析其临床资料、评估心肌梗死面积、左心室功能改变及血管开通率，分析院内（2～3周）及随访（12～36个月）主要心脏不良事件（MACE）及复合终点事件发生率，进而比较IPC对患者近期和远期预后的影响。结果①A组CK峰值、CK—MB峰值、CK到达峰值的时间、QRS积分、白细胞计数、超敏C反应蛋白、室壁运动异常节段数显著低于B组，而血管开通率和左室射血分数（LVEF）显著高于B组，两组差异均有显著性（P〈0．05）；②近期预后比较住院期间并发症及复合终点事件发生率A组低于B组，差异均具有显著性（P〈0．05）；③远期预后比较不稳定心绞痛、MACE事件及复合终点事件发生率差异无显著性（P〉0．05）。结论心肌缺血预适应对溶栓治疗患者具有明显再灌注保护作用，改善患者的近期预后，但对患者远期预后影响需进一步探讨。

Objective To evaluate the protective effects of ischemic preconditioning on short- and long-term outcomes in acute myocardial infarction （AMI） treated by thrombolysis. Methods Retrospective analysis of the clinical data was carried out in 152 patients with a first acute ST segment elevation myocardial infarction by thrombolytic treatment. In accordance with patients＇ condition all cases were divided into two groups： 80 cases with preinfarction angina within 24 hours before the onset of AMI as the group A, other 72 cases without preinfarction angina as group B. Results In group A , peak creatine kinase and. serum creatine kinase-MB, white cell count , QRS score , hs-CRP, ;left ventricular ejection fraction, the sum of abnormal regional wall motion were higher than group B, but the left ventricular function, major adverse cardiac events and sum adverse cardiac events were lovering than groupB.In long-term there was no significant difference in major or sum adverse cardiac events in group A and B. Conclusion Ischemic preconditioning in the cases with AMI after thrombolytic treatment only provided protective effects on short-term outcomes, no significient effects on long-term outcomes.