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目的：利用间接指标的方法，观察急性心肌梗塞（ＡＭＩ）后心肌再灌注损伤（ＭｙｏｃａｒｄｉａｌＲｅｐｅｒｆｕｓｉｏｎＩｎｊｕｒｙ，ＭＲＩ）的临床表现，了解ＭＲＩ对左室射血功能及梗塞后心绞痛的影响。方法：对尿激酶静脉溶栓后３２例冠脉再通者和１０例冠脉未再通者进行心电图和心肌酶学动态监测，ＡＭＩ后３周所有患者接受心脏彩超检查。结果：临床判断冠脉再通者中ＭＲＩ发生率为５６２５％（１８／３２），心电图主要表现为突发短暂性ＳＴ段明显抬高，其次是再灌注心律失常，束支或房室传导阻滞最少见。ＭＲＩ时血清ＣＰＫ峰值时间为１３８６±４２６小时，较冠脉再通而无ＭＲＩ组１９１７±５３６小时显著前移（Ｐ＜００５）。ＭＲＩ组ＬＶＥＦ（４５２５±１０７７％）显著高于冠脉未再通组（３８６０±９２５％）（Ｐ＜００５），但与无ＭＲＩ组（５３２８±１２７７％）相比，Ｐ＞００５。ＭＲＩ组梗塞后心绞痛发生率为２７２８％，与无ＭＲＩ组４２８０％和冠脉未再通组１０００％相比，Ｐ均＞００５。结论：ＡＭＩ静脉溶栓后部分患者发生再灌注损伤，ＭＲＩ对ＬＶＥＦ和梗塞后心绞痛发作无显著影响。
Objective: To observe the clinical manifestations of Myocardial reperfusionInjury (MRI) after acute myocardial infarction (AMI) and to investigate the effect of MRI on left ventricular ejection function and post-infarction angina pectoris by indirect method. Methods: Thirty-two patients with coronary artery recanalization and 10 non-recanalized coronary arteries after thrombolysis with urokinase were subjected to electrocardiogram and myocardial enzymology dynamic monitoring. All patients underwent cardiac echocardiography 3 weeks after AMI. Results: The prevalence of MRI in coronary recanalization was 5625% (18/32). The electrocardiogram mainly manifested as sudden transient ST segment elevation, followed by reperfusion arrhythmia, bundle branch or atrioventricular The most common block. Serum CPK peak time of MRI was 1386 ± 426 hours on MRI, which was significantly advanced compared with 1917 ± 536 hours after coronary recanalization without MRI (P <005). The LVEF in MRI group was significantly higher than that in non-recanalization group (4525 ± 1077% vs 3860 ± 925%, P <005) 1277%), P> 005. The incidence of post-infarction angina in MRI group was 2728%, P> 005 compared with 4280% in non-MRI group and 1000% in non-revascularization group. Conclusion: Some patients with AMI have reperfusion injury after intravenous thrombolysis. MRI has no significant effect on the incidence of LVEF and post-infarction angina pectoris.