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目的:分析急性心肌梗死(acutemyocardialinfarction,AMI)梗死相关动脉(infarctrelatedartery,IRA)的自溶现象,探讨自溶现象的影响因素和预后意义。方法:155例未予静脉溶栓的首次AMI患者,均在发病12小时内行直接经皮冠状动脉介入治疗(percutaneouscoronaryintervention,PCI)。所有患者按照有无自溶现象分为两组:自溶组(31例)和无自溶组(124例)。用放射性核素测定心功能,观察两组心力衰竭、再发心肌梗死的发生率和住院病死率。结果:①自溶组梗死前心绞痛的发生率显著高于无自溶组(P<0.01);CKMB、心肌肌钙蛋白I峰值均低于无自溶组(P<0.01,P<0.01),侧支循环发生率亦低于无自溶组(P<0.05);②自溶组心肌梗死面积小于无自溶组(P<0.05);左心室射血分数显著高于无自溶组;③多元Logistic回归分析结果显示,梗死前心绞痛和缺乏侧支循环是发生自溶现象的独立预测因素(P<0.01,P<0.05)。结论:梗死前心绞痛和缺乏侧支循环是发生自溶现象的独立预测因素,而自溶现象可缩小心肌梗死面积,保护心功能,改善预后。
Objective: To analyze the autolysis of infarct related artery (IRA) in acute myocardial infarction (AMI) and to explore the influencing factors and prognostic significance of autolysis. Methods: All 155 AMI patients without intravenous thrombolysis underwent percutaneous coronary intervention (PCI) within 12 hours of onset. All patients were divided into two groups according to the presence or absence of autolysis: autolysis group (31 cases) and no autolysis group (124 cases). Heart function was measured by radionuclide, the incidence of heart failure and recurrent myocardial infarction in both groups was observed, and hospital mortality was also observed. Results: (1) The incidence of angina pectoris in the autolysis group was significantly higher than that in the group without autolysis (P <0.01); the peak values of CKMB and cardiac troponin I were lower than those in the group without autolysis (P <0.01, P <0.01) The incidence of collateral circulation was also lower than that in the group without autolysis (P <0.05). ② The area of myocardial infarction in the autolysis group was smaller than that in the group without autolysis (P <0.05); the left ventricular ejection fraction was significantly higher than that in the group without autolysis Multiple logistic regression analysis showed that pre-infarction angina and lack of collateral circulation were independent predictors of autolysis (P <0.01, P <0.05). CONCLUSION: Pre-infarction angina and lack of collateral circulation are independent predictors of autolysis. Autolysis may reduce myocardial infarct size, protect cardiac function, and improve prognosis.