心肌缺血预适应在急性心肌梗死中的临床意义

The clinical significance of ischemic preconditioning in acute myocardial infarction.

目的 探讨心肌缺血预适应在 AMI中的临床意义。方法 12 0例初发 AMI患者 ,按 AMI发作前 48小时内有无心绞痛分为缺血预适应组 (IP组 n=6 6 )与对照组 (n=5 4) ,测定左心室射血分数 (L VEF)和左心室室壁运动情况、心肌酶 (CPK、CPK- Mb)峰值、心电图 QRS记分 ,观察住院期间心律失常、心功能不全、心源性休克和室壁瘤发生率并进行比较。结果 IP组 CPK、CPK- Mb峰值、心电图 QRS记分和心功能不全、频发室性期前收缩、VT/VF和 II- III°房室传导阻滞 (AVB)的发生率以及住院期病死率明显低于对照组 (P<0 .0 5 ) ,而 L VEF值明显高于对照组 (P<0 .0 5 )。结论 心肌缺血预适应在 AMI病人中发挥了心脏保护作用 ,有利于减少心肌梗死面积和左心室收缩功能的恢复 。

Objective To evaluate the benefit of ischemic preconditioning in acute myocardial infarction.Methods According to whether preinfarct angina or not within 48h before AMI,120 patients with initial onset AMI were divided into two groups which were preconditioning group(n=66) and control group(n=54). In these two groups,the infarct size ,cardiac systolic function and main complications were compared and left ventricular ejection fraction(LVEF) ,QRS score of ECG ,peak values of CPK and CPK-Mb and left ventricular wall motion were analyzed. Results The incidences of heart failure and malignant arrhythmia such as frequent ventricular premature beats,ventricular tachycardia ,ventricular fibrillation and atrio-ventricular block in preconditioning group were significantly lower than those in control group(P<0.05).In preconditioning group, QRS score and mortality were lower ,LVEF was higher and the peak values of CPK and CPK-Mb were significantly decreased(P<0.05). Conclusion Ischemic preconditioning has the benefit in patient with AMI which can protect myocardium ,limit infarct size ,preserve cardiac systolic function, abolish life-threatening arrhythmias and decrease in-hospital mortality.