【摘要】 目的　探讨梗死前有无心绞痛对急性心肌梗死 (AMI)预后的影响。方法　对 12 3例首次穿壁性AMI住院患者进行临床回顾性分析 ,阐明梗死之前心绞痛引起的缺血预适应效应对AMI的面积、心脏事件 (心力衰竭、心源性休克、严重心律失常 )发生率和心肌保护等方面所起的作用。结果　梗死前 4 8h有心绞痛的 94例AMI患者 (A组 )、血清肌酸磷酸激酶 (CPK)峰值、心肌肌酸激酶同功酶 (CK MB)、心脏事件 (心力衰竭、心源性休克、严重心律失常 )发生率与梗死前无心绞痛的 39例患者 (B组 )相比较均明显降低 (P <0 .0 5 ) ;超声心动图检查左心室射学分数 (LVEF) ,梗死后 4周两组无显著差别 (P <0 .0 5 ) ;2 4周后LVEF ,A组有提高 ,B组则降低 (P <0 .0 5 ) ;住院病死率A组显著低于B组 (P <0 .0 5 )。结论　AMI前有心绞痛的患者 ,心梗后梗死面积缩小 ,左室功能和临床预后的改善 ,与心肌缺血预适应 (IP)对心脏的保护密切相关。更多还原

【Abstract】 Objective To investigate the clinical and prognostic effects of myocardial ischemic preconditioning on acute myocardial infarction (AMI).Methods According to patient event ever having or not having angina pectoris before occurring AMI,the patients with AMI were divided into two groups:group A (ischemic preconditioning group,the patients ever having angina pectoris before occurring AMI) and group B (no ischemic preconditioning group,the patients not ever having angina pectoris before occurring AMI).Results By the clinical analysis of a total of 123 patients of AMI,we found that the present of angina before AMI may have effects on the infarct size,cardiac event rate (heart failure,cardiac shock and sever arrhythmia) during hospitalization; In contrast to control the group (group B),we found the group A that present of angina before AMI had fewer numbers of necrotic Q waves (P<0.05);the peak values of CPK was significantly decreased in patients with angina pectoris (group A) than in those without angina pectoris (group B) (P<0.05);the left ventricular ejection fraction at 24 weeks of postinfarction were improved in group A,but were decreased in group B (P<0.05);there were lower (group A) incidences of the in-hospital cardiac dysfunction and ventricular premature beats,ventricular cardiac dysfunction and ventricular tachycardia,ventricular fibrillation,atrioventricular block and death (group A) (all P<0.05).Conclusion The patients with angina pectoris before occurring AMI may have reduced infarct size,improved left ventricular function and reduce the complication occurrence role in the ischemic myocardial preconditioning.更多还原