心肌缺血预适应对急性心肌梗死患者临床及近期预后的影响

Effects of ischemic preconditioning and short- term prognosis of acute myocardial infraction

目的对初次急性心肌梗死（ＡＭＩ）发生前４８ ｈ有无发作过心绞痛的患者的临床及近期预后进行评价。方法 ７４例初次 ＡＭＩ的患者，接受住院常规治疗，按梗死前 ４８ ｈ有无心绞痛分为有 ＩＰ组（ ｎ＝ ３６）、无 ＩＰ组（ ｎ＝ ３８），两组基本临床情况相似。结果有ＩＰ组较无ＩＰ组心肌梗死范围小（Ｐ＜０．０１），心肌酶峰值低（Ｐ＜０．０１），恶性心律失常、心力衰竭、心源性休克发生率及病死率均明显降低（Ｐ＜０．０５）。结论心肌缺血预适应的作用可能有：缩小梗死范围，降低恶性心律失常发生率，维持梗死后心脏功能。

Objective To evaluate the short - term prognosis of first acute myocardial infraction(AMI) with or without angina within 48 hours before AMI. Methods 74 cases of first AMI who followed the routine treatment during hospitalzation were divided into two groups: ischemic precondition(IP) group (n = 36) with angina within 48 hours before AMI onset; no ischemic precondition(NIP) group(n = 38): without angina. The basic clinical characteristics of the two groups were similar. results The infarction size was smaller in the IP group than that in the NIP group(P < 0.01). The peak value of myocardial enzyme was lower in the IP than NIP group(P< 0.01), The incidences of malignant arrhythmia, heart failure, cardiogenic shock and cardiogenic mortality were also lower in IP group than those in the NIP group(P < 0.05). Conclusion IP can reduce the infarction size, reduce the arrhythmia morbidity and maintain heart function after AMI.