梗死前心绞痛对急性心肌梗死溶栓-再灌注的影响

目的 :探讨梗死前心绞痛与急性心肌梗死溶栓 再灌注的关系。方法 :对 2 7例梗死前 1周内有不稳定性心绞痛和 2 5例梗死前无心绞痛的患者进行比较。 2组基础临床情况相匹配。梗死范围大小根据血清酶和∑R、NQ来估计 ,冠脉再通时间以抬高最明显的ST段迅速下降达 5 0 %为准。结果 :溶栓后 30min内梗死前心绞痛组 33%冠脉再通 ,而梗死前无心绞痛组没有 1例再通 (P <0 0 0 5 ) ;6 0min内再通率分别为 5 9%和 36 % (P <0 0 0 5 ) ;再通时间分别为 (49± 16 )min和 (6 9± 19)min(P <0 0 5 )。在梗死前心绞痛组 ,反映梗死范围大小的血清酶均明显低 ,而∑R相对较高 ,NQ数目相对较少 (均P <0 0 5 )。结论 :梗死前心绞痛组溶栓效果较好 ,梗死范围较小 ,梗死前反复心绞痛可作为对溶栓治疗敏感的预测指标。

Effect of pre-infarction angina on coronary thrombolysis-reperfusion in patients with acute myocardial infarction

Aim：To explore the relationship between pre-infarction angina and coronary thrombolysis-reperfusion in patients with acute myocardial infarction（AMI）．Methods： By comparing the condition of 27 patients who had unstable angina during one week before AMI with that of 25 patients who had no pre-infarction angina，we found that the two groups did not differ significantly in terms of clinical base-line characteristics．The size of infarction was estimated based on the level of cardiacenzyme and ECC measurements （∑R，NQ）．The time of reopening was defined from the start of thrombolytic therapy to the time when ST-segment elevation abruptly decreased by 50％．Results：Reopening occurred within 30 min after the start of treatment in 33％ of the patients with pre-infarction angina，but in none of those without pre-infarction angina（P＜0．005）．Reopening rates at 60 min were 59％ and 36％ in the two groups，respectively（P＜0．005）．The duration of reperfusion were （49±16） min and （69±19） min respectively（P＜0．05）．The cardiac enzymatic indexes which reflected infarction size were all significantly lower in patients with pre-infarction angina than in those without （P＜0．05，respectively）．The ECG showed a higher R waves and a smaller numnber of Q waves in the group with pre-infarction angina the in the group without （P＜0．05，respectively）．Conclusion:The thrombolytic therapy is more effective and the size of infarction is smaller in patients with pre-infarction angina．The preinfarction angina could be regarded as a sensitive predictor for applying coronary thrombolysis promptly to patients with AMI．