梗塞前心绞痛对急性心肌梗塞患者的有益作用

43例首次穿壁性急性心肌梗塞(AMI)患者于静脉内溶栓后90min行冠状动脉造影.其中24例AMI前6h内有心绞痛(甲组),另19例梗塞前无心绞痛(乙组).尽管两组多支冠状动脉病变及侧支循环发生率相似.但甲组异常Q波导联数、QRS积分、CPK峰值及CPK峰值距发病时间显著低于乙组.而梗塞相关冠状动脉再通率显著高于乙组.22例IRA开通患者中,有心绞痛者其基础左心室功能较无心绞痛者好.出院前超声心动图检查显示,甲组左心室局部和整体收缩功能、舒张充盈明显改善,而乙组收缩功能降低、舒张充盈无明显变化.住院期心脏事件发生率甲组显著低于乙组.本文提示,梗塞前心绞痛可能由于早期心肌再灌注和缺血预适应对梗塞大小、左心室功能及预后具有益作用.     

心肌梗塞后心绞痛在预测冠状动脉病变严重性的价值

作者对53例首次穿壁性心肌梗塞患者于发病后6月内行左心室和冠状动脉造影，23例心肌梗塞后心绞痛患者（甲组）较30例梗塞后无心绞痛患者（乙组）冠状动脉受累血管数和多支冠状动脉病变发生率增高，梗塞区侧支循环和左心室局部室壁活动改善。甲组中单支冠状动脉病变患者的梗塞区冠状动脉自发性再通率显著高于乙组。本文提示，心肌梗塞后心绞痛可预测多支冠状动脉病变和梗塞区冠状动脉自发再通，特别是前壁梗塞时，因此，对心肌梗塞后有心绞痛的患者宜行冠状动脉造影，以期正确选择治疗方法，改善其预后。     

男性早发冠心病患者临床和冠脉病变特点

总结87例年龄≤45岁的男性早发冠心病患者（甲组）的临床和冠状动脉造影特点，并与同期146例年龄≥60岁的男性老年冠心病患者（乙组）作比较。结果显示：甲组患者的吸烟史和家族史明显高于乙组（74．7％比44．5％）及（32．2％比9．5％）。甲组患者以急性心肌梗塞发病者多见。冠脉造影显示：甲组患者以单支病变多见，甲组中急性心肌梗塞患者冠脉正常者占一定比例。     

研究急性心肌梗死的有效疗法

目的分析急性心肌梗死的临床治疗方式。方法在本次研究中选择2014年6月-2016年3月我院收治的50例急性心肌梗死患者作为研究对象,结合临床治疗方式差异分为甲组和乙组,分别给予基础治疗和在溶栓进行治疗,对治疗效果进行对比。结果对甲组和乙组的治疗效果进行分析和比较,实践证明,乙组的治疗效果优于甲组,数据对比后差异明显,对甲组和乙组的不良症状进行对比和分析,实践证明,乙组的不良反应率低于甲组,组间对比后具有明显的差异,统计学意义显著(P0.05)。结论对急性心肌梗死患者采用溶栓方式进行干预和治疗,其效果明显,能降低心肌梗死和心力衰竭的发生几率,值得临床推广和应用。     

急性心肌梗塞溶栓失败患者行补救性经皮腔内冠状动脉成形术临床研究

为评价溶栓失败急性心肌梗塞（AMI）行补救性经皮腔内冠状动脉成形术（PTCA）的疗效及安全性，对35例AMI患者溶栓后90min行冠状动脉造影。根据梗塞相关动脉开通情况，16例成功者（甲组）中12例7～21d后行延迟PTCA治疗；19例失败者（乙组）中13例（乙1组）即刻行补救性PTCA，其余6例（乙2组）溶栓失败而未行PTCA者给一般药物治疗。结果表明，甲级中12例行延迟PTCA，成功11例（91．6％），正例于PTCA中出现冠状动脉急性闭塞并致小灶下壁心肌梗塞；乙1组13例行补救PTCA，全部成功（100％）。甲组住院期总心脏事件发生率（19％）与乙1组（23％）相似，且出院前心功能无显著差异。而乙2组6例中住院期死亡率（33％）及总心脏事件发生率（50％）增高。提示AMI溶栓失败患者补救PTCA成功率高、并发症少，能减少住院期心脏事件并促进左心室功能改善。     

静脉应用尿激酶在治疗急性心肌梗塞中的价值

本文研究尿激酶治疗34例心肌梗塞(甲组)和38例对照(乙组)的心电图、二维超声心动图、冠状动脉造影和1年随访情况。结果发现,甲组的缺血相关动脉通畅率(68%)高于乙组(37%),侧支循环优于乙组(P<0.01),心室功能损害较乙组轻。但心肌梗塞后心绞痛、再梗塞发生率高于乙组(P<0.05),尽管甲组的近期病死率明显低于乙组(P<0.05),但两者远期病死率无显著差异(P>0.05)。     

急性心肌梗塞早期冠状动脉再通的酶学指标及其临床意义

急性心肌梗塞(AMI)患者50例,其中28例在冠状动脉造影(冠造)下进行溶栓治疗或经皮冠脉腔内成形术(PTCA);另有22例接受住院常规治疗。全部病例均系列测定血清肌酸肌酶(CK)及肌酸激酶MB同工酶(MB-CK)。结果显示,冠状动脉再通时血清CK及MB-CK水平骤升,峰值距AMI发病时间提前。MB-CK峰值距AMI发病时间≤14小时,提示与梗塞相关的冠脉再通,其敏感性为90.0%,特异性为87.5%;CK峰值距AMI发病时间也可用于判别AMI静脉溶栓后与梗塞相关的冠脉再遁,但其敏感性与特异性比MB-CK稍低。     

急性多部位心肌梗死心电图与冠状动脉造影相关研究

３７例心电图确诊为急性多部位心肌梗死（ＡＭＩ）患者，前壁＋下壁或侧壁ＡＭ１２３例，下壁＋侧壁或后ＡＭＩ１４例。冠状动脉造影示单支血管病甲组１７例，乙组９例；多支血管病变甲组６例和乙组５例。甲组左心室室壁活动异常积分、临床心功能分级及死亡率均显著高于乙组。但单支血管病变患者与多支血管病变患者的左心室功能及心脏事件发生率无显著差异。因此，首次多部位ＡＭＩ时，单支血管病变多见，且在累及前壁时，常由左前降     

冠状动脉重塑与冠心病临床表现的关系

目的探讨冠状动脉重塑与冠心病临床表现的关系.方法 40例急性冠状动脉综合征(甲组)和32例稳定性冠心病(乙组)患者于介入治疗前行血管内超声(IVUS)检查.测量冠状动脉病变处和近远端参考血管的外弹力膜横截面积(EEM CSA)、管腔横截面积、斑块面积.计算冠状动脉重塑指数(RI)= 冠状动脉病变处EEM CSA / 近远端参考血管处EEM CSA平均值.定义RI>1.05为正性重塑,RI<0.95为负性重塑,0.95＜RI＜1.05为无重塑.结果甲组以低回声软斑块多见(60% 和 31%),高回声硬斑块则在乙组中多见(69% 和 40%,P=0.015).EEM CSA甲组为(15.37±2.88 )mm2、乙组为 (13.35±2.87) mm2,P=0.004.斑块面积两组分别为(10.94±2.66) mm2 和 (9.30±2.66) mm2(P=0.011),两组的管腔横截面积和面积狭窄程度相似.RI甲组大于乙组(1.07±0.15 和 0.95±0.13, P=0.001),正性重塑在前者更多见(50% 和 25%),而负性重塑在后者较常见(22% 和 53%)(P=0.021).结论冠状动脉重塑与冠心病临床表现有关.结果甲组以低回声软斑块多见（60% 和 31%），高回声硬斑块则在乙组中多见（69% 和 40%，P=0.015)。EEM CSA甲组为（15.37±2.88 ）mm2、乙组为 (13.35±2.87) mm2,P=0004。斑块面积两组分别为（1094±2.66） mm2 和（9.30±2.66）mm2（P=0.011），两组的管腔横截面积和面积狭窄程度相似。RI甲组大于乙组（1.07±0.15 和 0.95±0.13,P=0.001），正性重塑在前者更多见（50% 和 25%），而负性重塑在后者较常见（22% 和 53%）（P=0.021）。结论冠状动脉重塑与冠心病临床表现有关。     

去氧孕烯炔雌醇片加米非司酮联合归脾丸治疗绝经过渡期功能性子宫出血的效果

选取86例于2014年1月到2015年12月来我院治疗的绝经过渡期功能性子宫出血患者,随机分为甲乙两组,每组43例。甲组患者使用去氧孕烯炔雌醇片加米非司酮联合归脾丸治疗,乙组使用去氧孕烯炔雌醇片联合米非司酮治疗。对比观察两组患者临床效果与不良反应发生情况。结果:甲组患者总体有效率为95.35%,乙组为79.07%,甲组明显高于乙组(P0.05),甲组出血时间明显短于乙组(P0.05),甲组控制时间明显长于乙组(P0.05),甲组突破性出血发生率明显低于乙组(P0.05),甲组不良反应发生率明显低于乙组(P0.05)。结论:给予绝经过渡期功能性子宫出血患者去氧孕烯炔雌醇片加米非司酮联合归脾丸治疗,效果显著,且不良反应小,值得临床推广。     

易化经皮冠状动脉介入治疗对急性心肌梗死后心室重构的阻抑作用

目的:通过平衡法核素心室造影(ERNA)方法,对比评价溶栓、经桡动脉入径直接经皮冠状动脉介入治疗(PCI)和易化PCI对老年急性心肌梗死(AMI)患者心室重构的阻抑作用。方法:选择发病10h内的首次急性前壁ST段抬高型心肌梗死患者143例,随机分为直接PCI组71例和易化PCI组72例,另选择同期入院且一般临床资料匹配,但仅行溶栓治疗的70例患者为溶栓组。3组患者分别于AMI后1周、28周行ERNA,测定左室收缩功能参数及反常容积指数(PVI),随访28周内主要恶性心脏事件(MACE)的发生率。结果:①直接PCI组在PCI前梗死相关动脉(IRA)开通率明显低于溶栓组和易化PCI组(8.45%:31.43%,χ2=11.69;8.45%:30.56%,χ2=11.09;均P<0.01)。易化PCI组术后IRA血流TIMI-3级率高于直接PCI组(98.61%:88.73%,χ2=4.35,P<0.05)。②AMI后28周随访时,易化PCI组左室射血分数(LVEF)、左室峰射血率(PER)较溶栓组增高(t=2.21、2.29,均P<0.05),同时左室峰射血率时间(TPER)、PVI降低(t=2.41、2.37,均P<0.05);易化PCI组LVEF、PER较直接PCI组增高(t=2.08和2.13,均P<0.05),同时TPER、PVI降低(t=2.10、2.49,均P<0.05)。③随访28周,易化PCI组和直接PCI组MACE发生率均低于溶栓组(8.33%:54.29%,χ2=35.05;8.45%:54.29%,χ2=34.49;均P<0.01);3组间主要脏器大出血和颅内出血的发生率均差异无统计学意义。结论:经桡动脉入径易化PCI治疗可早期充分、持久地开通IRA,能在AMI早期阻抑AMI急性左室重构过程,改善左室收缩功能,其效应优于直接PCI和单纯溶栓治疗。     

老年ST段抬高急性心肌梗死患者急诊介入与溶栓治疗比较

目的急性心肌梗死（AMI）后尽早恢复梗死相关动脉的再灌注是治疗中的首要问题。本研究旨在评价老年急性ST段抬高性心肌梗死（STEMI）分别接受直接经皮冠状动脉介入（PCI）治疗和溶栓治疗住院及随访期间的临床疗效差别。方法109例65岁以上老年STEMI患者,59例行直接PCI治疗,50例行溶栓治疗。比较2组梗死相关动脉（IRA）再通率、左室功能指标、病死率及主要心血管事件发生率的差别。结果PCI组IRA开通率明显高于溶栓治疗组,住院病死率明显低于溶栓治疗组,左室功能指标明显优于溶栓治疗组（左室射血分数更高、左室舒张末径较小、室壁运动障碍率较低。随访期间比较,PCI组再次血运重建率和心血管病死率明显低于溶栓治疗组。结论老年AMI患者行直接PCI治疗能够显著提高IRA再灌注成功率,保护心功能,减少再次血运重建,并且在降低病死率及心血管事件上也总体优于溶栓治疗。     

急性心肌梗塞早期溶栓后心电图ST段改变与预后

目的:探索急性心肌梗塞(AMI)早期溶栓治疗后,心电图抬高的ST段回降的幅度对临床预后的影响。方法: 描记88例AMI早期患者溶栓治疗后1 h、2 h、3 h、1 d、3 d等时段的心电图,根据有、无早期(溶栓后2 h)ST段的恢复分为三组:A组,ST段基本恢复至等电线,即回降的幅度≥90％;B组,ST段回降的幅度在50％～90％之间; C组,ST段回降的幅度不到50％。比较三组心肌酶、左心功能及住院病死率。结果:血清肌酸激酶(CK)峰值、左室射血分数(LVEF)及病死率,A组与B组、C组相比较有显著差异(P<0．05,或<0．01):A组CK峰值低、LVEF 高、预后好;C组则相反。结论:AMI早期溶栓后的心电图ST段变化,有助于对临床预后的评估。     

ST段早期恢复反映急性心肌梗死溶栓治疗后心肌再灌注

目的 比较溶栓再通后早期ST段恢复与未恢复者住院期间临床结局的差异，探讨ST段早期恢复在心肌再灌注中的作用。方法 108例溶栓经酶学等指标临床判定再通的急性心肌梗死（AMI）患者，按照有无早期（溶栓后2h)ST段恢复分为两组。连续测定血清肌酸激酶（CK）水平，了解心肌酶峰出现时间及峰值；放射性核素评估左心室功能。观察4周住院期间充血性心力衰竭（CHF）、室壁瘤、心肌梗死后心绞痛发生情况及病死率。结果 无论是前壁MI还是下壁MI，ST段早期恢复组左心室射血分数均高于未恢复组（P＜0．05）；CK峰值则低于未恢复组（P＜0．05）。住院期间ST段恢复组核素心肌显像充盈缺损、CHF及室壁瘤发生率低，心肌梗死后心绞痛发生率高（P值均小于0.05)。结论 同ST段未恢复组相比，溶栓再通后ST段早期恢复者临床预后好。心电图模式可以反映再灌注程度。     

A correlative study of ECG and coronary arteriogram findings after acute myocardial infarction

To evaluate the electrocardiographic value in the prediction of reperfusion state of the infarct-related artery (IRA), serial changes in ST segment elevation were assessed in 38 patients with acute myocardial infarction (AMI). ST segment elevation decreased by 35% or more within 8 hours of peak sigma ST in 16 of the 20 patients with subtotal occlusion, but in none of the patients with total occlusion of the IRA (P less than 0.01). Myocardial infarct size estimated by peak serum CK-MB, sigma Q and QRS score was smaller and left ventricular function was better in patients with rapid resolution of ST segment elevation than in those with persistent ST elevation. The study indicates that a fall of ST segment elevation by 35% or more of the peak sigma ST within 8 hours of infarction may be a useful indicator of early reperfusion of the IRA in patients with AMI.     

急性心肌梗死急诊介入治疗与溶栓治疗的疗效比较

目的比较急性ST段抬高性心肌梗死(STEMI)患者分别接受直接经皮冠状动脉介入(PCI)治疗和溶栓治疗住院及随访期间的临床疗效差别。方法108例STEMI患者,66例行直接PCI治疗(PCI组),42例行溶栓治疗(UK组)。比较2组梗死相关动脉(IRA)再通率、左室功能指标、病死率及主要心血管事件发生率的差别。结果PCI组IRA开通率高于UK组(P<0.01),住院病死率低于UK组(P<0.05),左室功能指标优于UK组(左室射血分数更高、左室舒张末径较小、室壁运动障碍率较低,P<0.05)。随访期间比较PCI组再次血运重建率低于UK组(P<0.01),心血管病死率低于UK组(P<0.05)。结论与溶栓治疗相比,PCI治疗能及时有效地开通梗死相关血管,改善左室功能,降低病死率和再次血运重建率。     

Reduction in ST segment elevation after thrombolysis predicts either coronary reperfusion or preservation of left ventricular function

The usefulness of a reduction in ST segment elevation to predict coronary reperfusion in myocardial infarction remains uncertain. ST segment changes and angiographic findings were compared in 45 patients soon after thrombolysis. The percentage ST segment change 3 hours after treatment (in the lead showing the greatest initial ST elevation) was compared with the TIMI perfusion grade (thrombolysis in myocardial infarction trial) obtained between 90 minutes and 3 hours after treatment. Global ejection fraction and regional wall motion were assessed by cineventriculography (11 (5) days (mean (SD))) and by gated blood pool imaging (44 (11) days). Prediction of coronary patency by a reduction of greater than 25% in ST segment elevation 3 hours after thrombolytic treatment had a sensitivity of 97% but a specificity of only 43%. Where the ST segment elevation was reduced by greater than 25% the global ejection fraction was well maintained whether or not the infarct vessel was patent. In patients with a reduction of less than 25% in ST elevation, the ejection fraction was significantly lower and regional wall motion abnormality more severe. Reduction in ST elevation of greater than 25% within 3 hours of thrombolysis indicates either a patent infarct artery or preservation of left ventricular function. When the ST segment elevation does not fall by greater than 25% persistent coronary occlusion is likely (predictive accuracy 86%) and is associated with a lower ejection fraction. These patients may benefit from further treatment or additional interventions.     

Reduction in ST segment elevation after thrombolysis predicts either coronary reperfusion or preservation of left ventricular function.

The usefulness of a reduction in ST segment elevation to predict coronary reperfusion in myocardial infarction remains uncertain. ST segment changes and angiographic findings were compared in 45 patients soon after thrombolysis. The percentage ST segment change 3 hours after treatment (in the lead showing the greatest initial ST elevation) was compared with the TIMI perfusion grade (thrombolysis in myocardial infarction trial) obtained between 90 minutes and 3 hours after treatment. Global ejection fraction and regional wall motion were assessed by cineventriculography (11 (5) days (mean (SD))) and by gated blood pool imaging (44 (11) days). Prediction of coronary patency by a reduction of greater than 25% in ST segment elevation 3 hours after thrombolytic treatment had a sensitivity of 97% but a specificity of only 43%. Where the ST segment elevation was reduced by greater than 25% the global ejection fraction was well maintained whether or not the infarct vessel was patent. In patients with a reduction of less than 25% in ST elevation, the ejection fraction was significantly lower and regional wall motion abnormality more severe. Reduction in ST elevation of greater than 25% within 3 hours of thrombolysis indicates either a patent infarct artery or preservation of left ventricular function. When the ST segment elevation does not fall by greater than 25% persistent coronary occlusion is likely (predictive accuracy 86%) and is associated with a lower ejection fraction. These patients may benefit from further treatment or additional interventions.     

Influence of thrombolytic therapy on inferior acute myocardial infarction with concomitant anterior ST segment depression.

The purposes of this study were to analyze the prognostic significance of precordial ST segment depression and to determine whether thrombolytic therapy is effective for all patients with inferior acute myocardial infarction (AMI) or whether there is a different effectiveness for patients with concomitant anterior ST segment depression persisting for 24 hours or longer. Medical charts of 176 patients were studied. On the basis of ECG the patients were subclassified into three groups according to the presence, persistence, or absence of significant ST segment depression: Group 1: anterior ST segment depression persisting for less than 24 hours (45.4%); Group 2: anterior ST segment depression persisting for more than 24 hours (17.6%); Group 3: no anterior ST segment depression (37%). Age, Killip class, peak creatine kinase, hospital deaths, left ventricular ejection fraction, regional wall motion score, postinfarction angina, and ventricular/supraventricular arrhythmia of all patients were studied. Parameters of the three groups were compared: worse results were found in group 1 and the worst in group 2. This result is independent of thrombolytic therapy. Finally, the same parameters of thrombolyzed and nonthrombolyzed groups were compared: no statistically significant difference was observed. Among thrombolyzed patients the number of those with ST depression lasting more than 24 hours is lower than in nonthrombolyzed patients. It can be assumed that thrombolytic therapy in inferior AMI determines a shifting of patients from a worse prognosis group (ST segment depression persisting for more than 24 hours) to a better prognosis group (ST segment depression persisting for less than 24 hours).     

急性心肌梗死再灌注后心电图ST段抬高的意义

目的：探讨急性心肌梗死（AMI）患者接受经皮冠状动脉腔内成形术（PTCA）治疗心电图ST段持续高与临床预后的关系。方法：AMI患者共30例,比较PTCA前及术后1h12导联心电图抬高ST的总和,按ST段下降幅度分为两组,A组：AT段下降≥50％,B组：ST段下降＜50％。行小剂量多巴酚丁胺负荷超声心动图检查并随访复查超声心动图。结果：AMI发病早期基础状态和负荷状态及发病后第1、2、3个月左室射血分数（LVEF）A组均明显大于B组。多巴酚丁胺负荷状态下主动脉峰值血流加速度、每搏输出量及每搏指数A组明显大于B组。基于状态和负荷状态下总室壁运动积分指数（GWMSI）和梗死区室壁运动积分指数（IWMSI）A组均明显小于B组,AMI发病后1、2、3个月GWMSI A组均明显小于B组。发病第1、2个月IWMSI两组间差异无统计学意义。发病第3个月IWMSI A组明显小于B组。AMI直接PTCA后心电图ST段持续抬高的患者左室收缩功能及收缩储备功能以及梗死区室壁运动的恢复明显低于ST段迅速下降者。