论文部分内容阅读
目的 :探讨侧支循环 (CR)和前驱心绞痛对急性心肌梗死 (AMI)患者梗死范围和心功能的影响及其可能的机制。方法 :119例首次AMI患者行选择性冠状动脉造影和左心室造影 ,分析冠状动脉CR及前驱心绞痛与AMI时肌酸激酶 (CK)峰值浓度和左室功能改变等的关系。结果 :①全组共 119例患者 ,兼有CR和前驱心绞痛者 (A组 ) 5 3例 ;有CR无前驱心绞痛者 (B组 ) 2 1例 ;仅有前驱心绞痛者 (C组 ) 2 6例 ;既无CR又无前驱心绞痛者 (D组 ) 19例。②心肌酶学改变 :A组CK峰值浓度显著低于D组 (P <0 .0 5 ) ,其CK同工酶 (CK MB)的峰值浓度显著低于D组和B组 (分别P <0 .0 1和 <0 .0 5 ) ;而且B组和C组的CK MB峰值浓度均低于D组 (均P <0 .0 5 )。③各组患者的心肌梗死部位、病变血管支数无统计学差异 ,但非Q波心肌梗死的比例A组显著高于D组(36 %对 2 1% ,P <0 .0 5 )。④心功能情况 :A组左室射血分数 (LVEF)显著高于其他各组 ,而且B组和C组的LVEF均高于D组 (P <0 .0 5 )。而室壁运动Cortina计分则A组明显低于其他各组 ,B组和C组均显著低于D组 (P <0 .0 5 )。结论 :冠状动脉CR和前驱心绞痛所致的缺血预适应对AMI患者的心肌均有重要的保护作用 ,而且二者可协同发挥作用
Objective: To investigate the influence of collateral circulation (CR) and angina pectoris on infarct extent and cardiac function in patients with acute myocardial infarction (AMI) and its possible mechanism. Methods: 119 patients with first AMI underwent selective coronary angiography and left ventricular angiography. The relationship between CR and angina pectoris and peak creatine kinase (CK) and left ventricular function were analyzed. Results: ①There were 119 patients with CR and angina pectoris (group A), 53 patients with CR without angina pectoris (group B), 21 patients with angina pectoris (group C) Cases; neither CR nor pre-angina (D group) 19 cases. ② The changes of myocardial enzymes: The peak concentration of CK in group A was significantly lower than that in group D (P <0.05), and the peak CK CK was significantly lower than those in group D and group B .0 1 and <0. 05), and the peak concentrations of CK MB in group B and group C were lower than those in group D (all P <0.05). ③ There was no significant difference in myocardial infarction and lesion vessel count between groups. However, the proportion of non-Q wave myocardial infarction in group A was significantly higher than that in group D (36% vs 21%, P <0.05). Cardiac function: Left ventricular ejection fraction (LVEF) of group A was significantly higher than that of other groups, and LVEF of group B and C were higher than that of group D (P <0.05). The Cortina scoring of wall motion was significantly lower in group A than in other groups, while group B and C were significantly lower than group D (P <0.05). CONCLUSIONS: Ischemic preconditioning induced by CR and angina pectoris has an important protective effect on myocardium of patients with AMI and their synergistic effect