缺血预处理对急性心肌梗死溶栓治疗冠脉再通及预后影响的临床分析

目的：探讨缺血预适应对急性心肌梗死（AMI）溶栓治疗后冠脉血管再通及近期预后的影响。方法：对86例AMI并进行尿激酶溶栓患者的临床资料进行分析，按梗死前有无心绞痛分为心绞痛组（IP）与非心绞痛组（对照组）。比较两组患者心肌酶浓度、冠脉再通率、左室功能及心脏事件发生率的差异。结果：（1）IP组尿激酶溶栓血管再通率及再通速率高于对照组（P〈0．05）；（2）IP组AMI后血清心肌酶峰值、梗死面积及心脏主要并发症及住院病死率明显低于对照组（P〈0．05）；（3）IP组AMI后EF恢复优于对照组（P〈0．05）。结论：缺血预处理对梗死前心绞痛的缺血心肌起明显的保护作用；可提高AMI溶栓后血管再通率。从而减少梗死面积和心肌损害程度。降低病死率。

Ischemic Preconditioning of Thrombolytic Therapy in Patients with Acute Myocardial Infarction Coronary Artery Recanalization and Clinical Analysis of the Impact on the Prognosis

Objective:To study the effect of ischemic preconditioning on the recanalization of coronary artery and short-term prognosis in the patients with acute myocardial infarction after thrombolytic therapy.Methods: The clinical data of 86 cases of AMI treated with urokinase thrombolysis were analysed.They were divided into groups of angina pectoris(IP) and non-angina group(the control group) according to the presence or obsence of angina pectoris before infarction.Then the myocardial enzyme concentration,coronary recanalization rate,left ventricular function and the incidence of cardiac events were compared between the two groups.Results:(1) In IP group the vascular recanalization rate was higher than that in control group(P<0.05).(2) In IP group the peak of serum myocardial enzymes,cardiac infarction area and major complications and fatality rate in hospital were significantly lower than that in control group(P<0.05).(3)In IP group the EF recovery after AMI was better than that in control group(P<0.05).Conclusion: The angina pectoris before infarction has protective effect on the ischemic myocardium.It can increase the vascular recanalization rate after thrombolysis and thereby reduce myocardial infarction size and the degree of damage,and reduce the mortality.