心肌缺血预适应对初次心肌梗塞面积及左室功能的影响

Effects of ischemic preconditioning on infarct size and left ventricular functions of patients with first acute myocardial infarction

目的评价首次急性心肌梗塞（ＡＭＩ）前４８小时内发生的心绞痛（ＡＰ）对梗塞面积和心功能的影响。方法根据ＡＭＩ前４８小时内有无ＡＰ发作情况进行分组。无ＡＰ组（２２例）及ＡＰ组（２９例）。比较两组病人严重心功能障碍发生率及严重心律失常发生率，肌酸磷酸激酶（ＣＰＫ）峰值，用核素心肌断层显像测得左室梗塞范围，用核素门控心室显像测得左室功能参数。结果无ＡＰ组及ＡＰ组严重心功能障碍发生率分别为２７３％（６例）及６９％（２例），两组病人差异有显著性（Ｐ＜０．０５）；严重心律失常发生率分别为１３６％（３例）及１０３％（３例），两组间差异无显著性（Ｐ＞０．０５）；ＣＰＫ峰值分别为１５４２７±１０８６４及９８４３±７７５０Ｕ／Ｌ，核素心肌断层显像测得的左室梗塞节段数分别为５９±２８及４５±２４；核素门控心室显像测得的左室射血分数分别为３９４％±１１５％及５１５％±９８％，高峰充盈率分别为１９１±０６６及２２４±０５１ＥＤＶ／ｓ，高峰射血率分别为１９８±０６６及２５４±０５９ＥＤＶ／ｓ，室壁矛盾运动发生率分别为２７３％（６例）及６９％（２例）；ＣＰＫ值、梗塞节段数、左室功能指标及?

Purpose To evaluate the effect of angina pectoris (AP) prior to first acute myocardial infarction (AMI) on infarct size and left ventricular function Methods Patients were divided into 2 groups based on presence of AP within 48 hours before AMI onset, non AP group (n=22) and AP group (n=29) Incidences of severe cardiac function disturbances and severe arrhythmias, infarct size detected by 99m Tc MIBI SPECT myocardial perfusion imaging and left ventricular function detected by gated cardiac blood pool imaging between 2 groups were compared Results Incidences of severe cardiac function disturbance were 27 3% (n=6) and 6 9% (n=2) between non AP group and AP group respectively The difference was significant (P<0 05) Incidences of severe arrhythmias were 13 6% (n=3) and 10 3% (n=3) respectively, no significant difference was found (P>0 05) Peak values of CPK were 1 542 7±1 086 4U/L and 984 3±775 0U/L respectively (P<0 05) Numbers of infarct segment were 5 9±2 8 and 4 5±2 4 respectively (P<0 001) LVEF was 39 4%±11 5% and 51 5%±9 8%, PFR 1 91±0 66EDV/s and 2 24±0 51EDV/s, PER 1 98±0 66EDV/s and 2 54±0 59EDV/s between non AP group and AP group respectively (P<0 05 or 0 001) 6 (27 3%) and 2 (6 9%) showed dyskinesis respectively (P<0 05) Conclusions Patients with AP within 48 hours before AMI onset can reduce infarct size and preserve left ventricular function These favorable effects of AP were related to ischemia preconditioning