心肌缺血预适应现象与心肌梗塞临床及预后关系的研究

目的：探讨心肌缺血预适应对心肌梗塞临床及预后的影响。方法：对３８５例心肌梗塞患者的临床及随访资料进行分析，按梗塞前有无心肌缺血表现分为Ａ、Ｂ两组。结果：Ａ组心肌梗塞时心肌坏死范围、心肌酶峰值、心律失常、左心衰竭、室壁瘤形成及病死率均明显低于Ｂ组，而梗塞后心绞痛及再次心肌梗塞的发生率却明显高于Ｂ组。两组差异显著（Ｐ＜０．０５或＜０．０１）。结论：心肌缺血预适应的临床意义有：①使再次缺血的程度减轻。②降低心律失常的发生率，提高室颤阈。③缩小梗塞范围。④维持梗塞后心脏功能。

Correlation between myocardial ischemic preconditioning and clinical manifestations and prognosis of myocardial infarction

Objective:To investigate the effect of ischemic preconditioning on clinical manifestations and prognosis of myocardial infarction.Methods:The clinical and followup data of 385 cases of acute myocardial infarction were analyzed.The patients were divided into two groups (A and B) according to the presence or absence of the manifestations of myocardial ischemia prior to myocardial infarction.Results:Group A had a smaller size of myocardial necrosis during infarction,lower peak value of myocardial enzymes,lower incidence of cardiac arrhythmia,left heart failure and ventricular aneurysm,and lower mortality than group B.However,the incidence of postinfarction angina and the recurrence of infarction were significantly higher in group A than those in group B( P <0 05 or <0 01).Conclusions:The clinical significance of myocardial ischemic preconditioning is as follows:(1)The severity of recurrent ischemia is alleviated.(2)The incidence of cardiac arrhythmia is decreased,and the threshold of ventricular fibrillation is increased.(3) The size of infarct is reduced.(4)The cardiac function is maintained after infarction.