急性心肌梗死前心绞痛对冠状动脉介入术后近期心功能影响.docVIP

急性心肌梗死前心绞痛对冠状动脉介入术后近期心功能影响 　 作者：刘智勇 张翼 谭玉荣 周平 熊天平 袁旭明 【关键词】 梗死前心绞痛 　　【摘要】 目的 探讨梗死前心绞痛对急性心肌梗死（AMI）患者经皮冠状动脉介入术（PCI）后近期心功能的影响。方法 63例AMI患者根据有无梗死前心绞痛分3组:A组无梗死前心绞痛18例；B组梗死前48h内有心绞痛史23例；C组梗死前＞48h有心绞痛史22例。所有患者均在发病6h内行直接PCI术。术前术后动态观察心肌酶变化，术后2周测定左室射血分数（LVEF）。结果 A组肌酸激酶同工酶峰值显著高于B、C两组（P＜0.01）；C组侧支循环数显著多于A、B两组（P＜0.05）；B组LVEF显著高于A、C两组（P＜0.01），A、C两组无统计学差异。结论 梗死前48h内心绞痛可能通过诱导心肌缺血预适应来改善AMI患者心室收缩功能；梗死前＞48h心绞痛可能通过建立侧支循环来改善AMI患者心室收缩功能。 　　【关键词】 梗死前心绞痛；经皮冠状动脉介入治疗；心室收缩功能 　　Effects of preinfarction angina on ventricular function after percutaneous coronary intervention in patients with acute myocardial infarction 　　【Abstract】 Objective To evaluate recent effects of preinfarction angina on ventricular function after direct percutaneous coronary intervention(PCI) in patients with acute myocardial infarction(AMI).Methods Sixty three patients with AMI were divided into three groups:no previous angina(group,n=18);preinfarction angina occurring within 48h before onset of AMI (group B,n=23);preinfarction angina occurring＞48h before onset of AMI (group C,n=22).All patients underwent direct PCI within 6h after onset of AMI;Myocardial enzymes were continuously measured before and after PCI;left ventricular ejection fraction(LVEF) was measured at 2 weaks.Results The peak creatine MB fraction was significantly higher in group A than that in the other groups (P＜0.01).Compared with the other groups, the number of compensatory circulation in group C was increased.he LVEF parameters in group A were significantly better than those in the other groups.Conclusion Preinfarction angina within 48h before AMI onset can improve ventricular function by ischemic preconditioning(IP) after PCI in AMI patients.reinfarction angina occurring＞48h before AMI onset maybe improve ventricular function by compensatory circulation. 　　【Key words】 preinfarction angina;acute myocardial infarction;percutaneous coronary intervention;ventricular function 　　经皮冠状动脉介入治疗(PCI)已成为急性心肌梗死(AMI)治疗的有效方法,能显著改善AMI患者的预后。有报道［1］梗死前心绞痛患者在AMI溶栓再通后,其心源