摘要
目的 探讨缺血预适应 (IPC)对急性心肌梗死 (AMI)患者经皮冠状动脉腔内成形术 (PTCA)后左室功能和近期临床预后的影响。方法 将 4 0例成功实施PTCA的初次AMI患者按是否并发梗死前心绞痛 (PA)分为二组 :PA(+)组 2 3例 ,患者在梗死前 2 4h内至少有 1次心绞痛发作 ;PA(- )组 17例 ,梗死前无心绞痛史。应用超声心动图观察PTCA术前及术后 2周射血分数 (LVEF)、左室短轴缩短分数 (LVFS)、左室舒张末容积 (LVEDV)以及左室收缩末容积 (LVESV)的变化。统计PTCA后 2周内心脏事件的发生率。结果 ①二组患者在PTCA前的LVEDV、LVESV、LVEF及LVFS差异均无统计学意义 (P >0 .0 5 ) ;②PTCA术后 2周 ,PA(+)组LVEDV及LVESV明显缩小 (P <0 .0 1,0 .0 5 ) ,LVEF及LVFS显著提高 (P <0 .0 5 ,0 .0 1)。PA(- )组术后LVEDV、LVESV及LVFS均达到明显改善 ,但手术前后LVEF无明显变化 (P >0 .0 5 ) ;③PTCA术后 2周 ,二组患者各指标进行组间比较 ,PA(+)组LVEDV[(10 1.0± 2 7.1)比 (12 2 .7± 2 6 .3)ml,P <0 .0 5 ]及LEVSV[(5 0 .1± 2 7.0 )比 (70 .2± 2 6 .7)ml,P <0 .0 5 ]缩小程度PA(- )组明显 ,LVEF[(5 7.4± 13.6 )比 (4 6 .1± 12 .6 ) % ,P <0 .0 5 ]及LVFS[(34.7± 4 .8)比 (2 7.8±4 .1) % ,P <0 .0 1]提高的程度显?
Objective To study effects of ischemic preconditioning(IPC) on left ventricuar function and short-term prognosis in acute myocardial infarction(AMI) with percutaneous transluminal coronary angioplasty(PTCA). Methods 40 cases with primary AMI who followed PTCA successfully were divided into two groups:preinfarction angina(PA)(+) group:23 patients with episodes of prodromal angina within 24 hours before AMI onset,PA(-) group:17 patients without angina before infarction.LVEF、LVFS、LVEDV and LVESV were determined with echocardiography pre-and post-PTCA at 14d and the incidences of cardiac event during two weeks after PTCA were analyzed. Results After successful PTCA,LVEDV and LVESV were decreased significantly in PA(+)group than those in PA(-) group (both P<0.05),LVEF and LVFS were increased significantly in PA(+)group than those in PA(-) group(P<0.05,0.01).During two weeks after PTCA, there had no significantly difference in incidence of in-hospital death、reinfarction or recurrent ischemic pain.However,incidences of congestive heart failure and serious arrhythmia were significantly lower in PA(+) group than those in PA(-) group(both P<0.05). Conclusion IPC can preserve the left ventricular pump function in course of left ventricular remodeling in patients with AMI treated by PTCA successfully, and can improve short-term prognosis.
出处
《中国心血管病研究》
CAS
2004年第11期851-854,共4页
Chinese Journal of Cardiovascular Research
关键词
缺血预适应
经皮冠状动脉腔内成形术
心肌梗死
梗死前心绞痛
ischemic preconditioning
percutaneous transluminal coronary angioplasty
myocardial infarction
preinfarction angina pectoris
