【摘要】 目的　探讨梗死前心绞痛 (缺血预处理 )对急性心肌梗死 (AMI)溶栓治疗后冠脉血管再通率、再通速率、梗死面积及心室功能的影响。方法　将 90例AMI住院患者分为心绞痛组与非心绞痛组 ,均一次性给予尿激酶 15 0～ 2 0 0万U溶栓。连续监测特异性血清心肌酶 ,计算血管再通时间 ,按Wagner方法计算早期及最后 (1周后 )心肌梗死面积 ,超声心动图测定左室射血分数 (EF)。结果　 (1)心绞痛组AMI后血清心肌酶峰值明显低于非心绞痛组〔(12 44 5± 14 7 4)IU·L- 1 vs .(162 4 3± 199 7)IU·L- 1 ,P <0 0 5〕 ;(2 )心绞痛组心肌梗死面积 (QRS积分 )明显小于非心绞痛组〔(4 .0± 1 5 )分vs .(5 1±2 0 )分 ,P <0 0 5〕 ;(3 )心绞痛组尿激酶溶栓血管再通率及再通速率高于非心绞痛组〔82 9%vs .60 .5 % ,P <0 0 5 ;(67.4±13 .6)minvs .(95 4± 16 5 )min ,P <0 0 5〕 ;(4 )心绞痛组AMI后EF恢复优于非心绞痛组〔(5 6.2± 9.5 ) %vs .(4 5 .7± 6 7) % ,P <0 0 5〕 ,且心脏主要并发症及住院病死率明显降低 (P <0 0 5 )。结论　梗死前心绞痛对缺血心肌起明显的保护作用 ,对提高急性心肌梗死溶栓后血管再通率、再通速率有益更多还原

【Abstract】 Objective To study the effect of preinfarction angina(ischemia preconditioning,IP) on coronary recanalization rate,coronary recanalization velocity,infarct size and ventricular function in acute myocardial infarction (AMI)patients treated with intravenous thrombolysis.Methods Ninety patients with AMI were divided into preinfarction angina group and nonpreinfarction angina group according to whether angina occurred in a week before AMI.Every patient was given urokinase 1.5～2.0 million units at one time,then successively,the specific serum myocardial enzymes were monitored,the coronary recanalization time and infarct size by Wagner , method were caculated,and the left ventricular ejection fraction was determinated by echocardiogram.Results After AMI,the peak value of myocardial enzyme and the size of infarct in preinfarction angina group were significantly lower than nonpreinfarction angina group(P<0.05).Coronary recanalization rate and coronary recanalization velocity were higher in preinfarction angina group,with better recovery of left ventricular function and obviously lower cardial main complication and hospitalization mortality(P<0.05).Conclusion IP has an obviously protective effect on ischemia myocardium and is beneficial for raising coronary recanalization rate and coronary recanalization velocity in AMI patients treated with intravenous thrombolysis.更多还原