心肌缺血预适应对急性心肌梗死病人的影响

Effects of ischemic preconditioning on short-termprognosis of acute myocardial infarction

目的对首次急性心肌梗死（AMI）发生前23h、24～48h、大于48h有无发作过心绞痛的病人的临床状况及近期预后进行评价。方法158例AMI病人分为缺血预适应组46例，其中24h内发生心绞痛11例，24～48h内发生心绞痛6例，大于48h发生心绞痛29例；非预适应组112例；两组基本临床情况相似。结果心肌缺血预适应组比非缺血预适应组心肌梗死范围小（P＜0．01），血浆CPK、LDH、AST峰值低（P＜0．01）、住院期间发生心功能不全、心源性休克、死亡等心脏事件发生率明显减低（P＜0．05）。但大于48h发生心绞痛AMI的梗死面积、CPK、LDH、AST峰值、心脏事件发生率与对照组无显著差异，两者心律失常发生率未见显著差异。结论首次急性心肌梗死前48h以内发作的心绞痛对AMI心肌具有明显的保护作用，其机理可能与心肌缺血预适应有关。

Objective To evaluate the clinical results of the first acute myocedial infarction (ANT) with angina in24 hours, 23~ 28 hours, and over 48 hours before AMI accure and not. Methods 158 cases of the first AMI were devidedinto two groups: ischemia preconditioning (P) group (n = 46) with angina in 24 hours, 24 ~ 28 houxs and over 48 hours be-fore AMI onset, no ischemia preconditioning (NIP) group (n = 112) withou angina. The basic clinical characteristics of thetwo groups were similar. Results The infarction size was smaller in the IP group than those in the NIP group (P < 0.01),the peak value of CPK, LDH and were lower in the IP than tha in the NIP group (P < 0.01), The incidenCes of heartfailure, cardiolgenic shock and cediolgenic mortality during hospitalization were the lower in IP group than those in the NIPgroup (P < 0.05), Therefore, one with angina over 48 hours before AMI was similar with NIP group in clinical results (P >0.05). The incidence of arrhythmia was also similar (P > 0.05) Conclusion The angina withen 48 hours before the firstAMI onset have dafinit cedoprofective effect, these effects are related to the ischemia preconditioning.