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目的及时恢复缺血区的血液灌注即再灌注是临床上挽救缺血心肌的最有效措施,但再灌注会引起严重的再灌注损伤。心肌缺血预适应(IP)可以减轻缺血再灌注损伤后心肌的坏死与心肌功能障碍。本文通过临床研究,分析探讨IP患者的临床指标变化及患者预后,观察其对急性心肌梗死(AMI)患者溶栓治疗效果的影响。方法本研究选取2011年1月—2014年12月收住入院的初发AMI患者222例,分为IP组120例及非IP组102例。2组患者皆给予尿激酶150万U+生理盐水100 ml,于30 min内静脉滴入,6 h后给予低分子肝素5000 U,12 h一次,连用7 d。其他药物据情况而定,比较2组患者磷酸肌酸激酶同工酶(CK-MB)、肌钙蛋白T(CTnT)峰值、左室射血分数(LVEF)、冠状动脉再通率及再通时间;以及住院期间心力衰竭、严重心律失常、心源性休克、梗死后心绞痛发生率和近期病死率。计量资料用t检验,数据用(x±s)表示,计数资料用χ2检验,数据用百分比表示。结果 IP组CK-MB、CTnT峰值比非IP组低[(112±89)U/L,(2.5±1.7)ng/ml vs.(138±93)U/L,(3.4±2.5)ng/ml],差异有统计学意义(P<0.05)。IP组比非IP组的左室射血分数高[(51.2±12.4)%vs.(43.7±13.9)%],差异有统计学意义(P<0.05)。IP组的冠状动脉再通率比非IP组高[85.0%(102/120)vs.65.7%(67/102)]及再通时间皆比非IP组短[(4.12±1.38)h vs.(5.01±1.21)h],差异有统计学意义(P<0.05)。预后及病死率方面,IP组的住院期间心力衰竭、严重心律失常、心源性休克和梗死后心绞痛发生率均较非IP组低(P<0.05)。结论有心肌缺血预适应的AMI患者进行尿激酶静脉溶栓治疗的效果较无心肌缺血预适应者更优,心肌缺血预适应对心肌有保护作用。
Objective To promptly restore blood perfusion in ischemic area, ie reperfusion is the most effective measure to save ischemic myocardium, but reperfusion can cause severe reperfusion injury. Myocardial ischemic preconditioning (IP) can relieve myocardial necrosis and myocardial dysfunction after ischemia-reperfusion injury. In this paper, clinical research, analysis and analysis of IP patients with changes in clinical indicators and prognosis of patients with acute myocardial infarction (AMI) to observe the effect of thrombolytic therapy. Methods A total of 222 AMI patients admitted to hospital from January 2011 to December 2014 were selected and divided into 120 cases of IP and 102 cases of non-IP. Two groups of patients were given 1.5 million urokinase U + saline 100 ml intravenously within 30 min, 6 h after the low molecular weight heparin 5000 U, 12 h once, once every 7 d. According to the situation, the other drugs were compared. The CK-MB, CTnT, LVEF, coronary recanalization rate and recanalization were compared between the two groups Time; and heart failure during hospitalization, severe arrhythmia, cardiogenic shock, post-infarction angina and recent mortality. Measurement data using t test, the data (x ± s) said the count data with χ2 test, the data expressed as a percentage. Results The peak values of CK-MB and CTnT in IP group were significantly lower than those in non-IP group [(112 ± 89) U / L, (2.5 ± 1.7) ng / ml vs. (138 ± 93) U / ml], the difference was statistically significant (P <0.05). Compared with non-IP group, IP group had higher left ventricular ejection fraction [(51.2 ± 12.4)% vs (43.7 ± 13.9)%], the difference was statistically significant (P <0.05). The rate of coronary recanalization in IP group was higher than that in non-IP group [85.0% (102/120) vs 65.7% (67/102)] and the recanalization time was shorter than non-IP group [(4.12 ± 1.38) h vs. (5.01 ± 1.21) h], the difference was statistically significant (P <0.05). In terms of prognosis and mortality, the incidence of heart failure, severe arrhythmia, cardiogenic shock and post-infarction angina pectoris in IP group were lower than those in non-IP group (P <0.05). Conclusions AMI patients with myocardial ischemic preconditioning are superior to intravenous thrombolytic therapy of urokinase compared with those without myocardial ischemic preconditioning. Myocardial ischemic preconditioning has a protective effect on myocardium.