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目的 :探讨梗死前心绞痛对急性心肌梗死 (AMI)患者直接经皮冠状动脉介入治疗 (PCI)术后心功能的影响。方法 :87例首次AMI患者 ,按梗死前有无心绞痛分为 3组 :A组 :无心绞痛史 30例 ;B组 :梗死前 4 8h内有心绞痛史 39例 ;C组 :仅在梗死前 >4 8h有心绞痛史 18例。所有患者均在发病 6h内行直接PCI术。术前术后动态监测心肌酶谱变化 ;术后 2周行99mTc心血池显像测定心功能和心室收缩同步性。比较 3组患者心功能和心室收缩同步性的差异。结果 :①B组肌酸激酶同工酶峰值显著低于A组 (P <0 .0 1)。②B组左室射血分数、左室峰射血率和左室峰射血时间均显著好于A组 (P <0 .0 1) ;左室舒张功能 :B组左室峰充盈率和左室峰充盈时间均好于A组 (P <0 .0 5 )。③B组左室相角程、左室半高宽和峰相位标准差均低于A组 (P <0 .0 5 )。以上各参数 ,C组和A组比较差异均无统计学意义。结论 :首次AMI前 4 8h内心绞痛发作可导致心肌缺血预适应 (Ischemicpre conditioning ,IP)的产生 ,并可保护有IP的AMI患者直接PCI术后的心功能和心室收缩同步性
Objective: To investigate the effect of pre-infarction angina on cardiac function in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Methods: 87 AMI patients were divided into 3 groups according to the presence or absence of angina pectoris before infarction: group A: 30 cases without angina pectoris; group B: 39 cases with angina pectoris within 48 hours before infarction; group C: 4 8h history of angina in 18 cases. All patients underwent direct PCI within 6 hours of onset. The changes of myocardial enzymes were monitored preoperatively and postoperatively. The synchronicity of heart function and ventricular systole were measured by 99mTc blood pool imaging two weeks after operation. Differences in cardiac function and systolic synchrony between the three groups were compared. Results: ① The peak of creatine kinase isozyme in group B was significantly lower than that in group A (P <0.01). ② The left ventricular ejection fraction, left ventricular peak ejection rate and left ventricular peak ejection time in group B were significantly better than those in group A (P <0.01). Left ventricular diastolic function: Peak filling time was better than group A (P <0.05). ③ The standard deviation of left ventricular phase angle, half width of the left ventricle and peak phase of the left ventricular were lower in group B than in group A (P <0.05). The above parameters, C group and A group were no significant difference. CONCLUSIONS: Angina pectoris attacks within 48 h of the first AMI can result in the production of ischemic preconditioning (IP) and the synchronization of cardiac function and ventricular contractility after direct PCI in AMI patients with IP