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目的观察心肌缺血预适应对溶栓治疗急性ST段抬高型心肌梗死(STEMI)的心肌保护作用。方法选择首次因急性STEMI行溶栓治疗的患者92例,根据心肌梗死发病前48h内有无心绞痛发作分为缺血预适应A组(47例)和无缺血预适应B组(45例),两组患者的基础资料比较无统计学差异。比较两组患者的心肌酶学改变、心功能、心脏事件的发生率和病死率。结果入院时,缺血预适应A组的LVEF、FS均显著高于无缺血预适应B组(P均<0.05);缺血预适应A组的LVEDD、LVESd均显著短于无缺血预适应B组(P均<0.05);溶栓治疗后,缺血预适应A组的cTnI和CK-MB的峰值浓度均显著低于无缺血预适应B组(P均<0.05),缺血预适应A组的cTnI和CK-MB的峰值时间、恢复正常时间均显著短于无缺血预适应B组(P均<0.05);住院后4周内,缺血预适应A组心律失常、心力衰竭、心源性休克等并发症的发生率及病死率均显著低于无缺血预适应B组(t=4.4256,4.3708,4.7298,5.4136,P均<0.05);但缺血预适应A组梗死后心绞痛的发生率显著高于无缺血预适应B组(t=4.1903,P<0.05);两组患者再发心梗的发生率比较无显著差异(t=0.2279,P>0.05)。结论初次AMI前48h内心绞痛的发作(心肌缺血预适应)对心肌具有保护作用,可维护心功能,减轻心肌损伤,降低并发症的发生率及住院病死率。
Objective To observe the myocardial protective effects of myocardial ischemic preconditioning on thrombolytic therapy in acute ST-segment elevation myocardial infarction (STEMI). Methods Ninety-two patients with acute STEMI thrombolysis were divided into two groups according to the presence of angina pectoris within 48 hours before the onset of myocardial infarction: group A (47 cases) and group B (45 cases) without ischemic preconditioning There was no significant difference between the two groups in the basic data. Myocardial enzymology changes, cardiac function, incidence of cardiac events and mortality were compared between the two groups. Results At admission, the LVEF and FS in ischemic preconditioning group A were significantly higher than those in ischemic preconditioning group B (all P <0.05). LVEDD and LVESd in ischemic preconditioning group A were significantly shorter than those in ischemic preconditioning group (P <0.05). After thrombolytic therapy, the peak concentrations of cTnI and CK-MB in ischemic preconditioning group A were significantly lower than those in ischemic preconditioning group B (all P <0.05), ischemic Pretreatment group A cTnI and CK-MB peak time and return to normal time were significantly shorter than those without ischemic preconditioning group B (P all <0.05); within 4 weeks after hospitalization, ischemic preconditioning group A arrhythmia, Heart failure, cardiogenic shock and other complications and mortality were significantly lower than those without ischemic preconditioning group B (t = 4.4256,4.3708,4.7298,5.4136, P all <0.05); but ischemic preconditioning A The incidence of angina after infarction in group B was significantly higher than that in group B without ischemic preconditioning (t = 4.1903, P <0.05). There was no significant difference in the incidence of recurrent myocardial infarction between the two groups (t = 0.2279, P> 0.05) . Conclusions The occurrence of angina pectoris (myocardial ischemic preconditioning) within 48 hours before the first AMI has a protective effect on the myocardium, which can maintain the cardiac function, reduce the myocardial injury, reduce the incidence of complications and in-hospital mortality.