既往或(和)梗死前心绞痛对急性心肌梗死病人左心室功能的影响  

THE EFFECTS OF PREVIOUS AND/OR PRODROMAL ANGINA PECTORIS ON LEFT VENTRICULAR FUNCTION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

作　　者：纪义国[1] 尹作民 王鲁民 

机构地区：[1]青岛市急救中心,山东青岛266023 [2]青岛市中心医院急救中心

出　　处：《齐鲁医学杂志》2005年第4期286-288,290,共4页Medical Journal of Qilu

摘　　要：①目的探讨既往或(和)梗死前心绞痛对急性心肌梗死(AMI)病人左心室(左室)功能的影响.②方法行选择性冠状动脉造影和左室造影252例首次急性心肌梗死病人中,兼有既往和梗死前心绞痛者46例(A组),单纯既往心绞痛者112例(B组),单纯梗死前心绞痛者43例(C组),梗死前无心绞痛者51例(D组),比较既往或(和)梗死前心绞痛对肌酸激酶(CK)峰值浓度、肌酸激酶同工酶(CK-MB)峰值浓度、冠状动脉侧支循环和左室功能等的影响.③结果A组CK峰值浓度显著低于D组(F=8.17,q=4.13,P＜0.05);A组CK-MB峰值浓度显著低于B、D组(F=6.52,q=9.14、3.27,P＜0.05),B、C组CK-MB峰值浓度显著低于D组(q=4.02、2.95,P＜0.05).A组非Q波心肌梗死发生率显著高于D组(x2=4.74,P＜0.05).A、B组冠状动脉侧支循环分级明显好于C、D组(u=2.284,P＜0.05).A组左室排血分数(LVEF)显著高于其他各组,B组和C组LVEF均显著高于D组(F=13.85,q=3.52～12.86,P＜0.05).而A组Critina记分则明显低于其他各组,B组和C组均显著低于D组(F=9.36,q=4.15～15.32,P＜0.05).④结论既往心绞痛促进冠状动脉侧支循环的建立,梗死前心绞痛可能导致缺血预适应的产生,二者协同对急性心肌梗死后的心脏功能起保护作用.Objective To investigate the short term effects of previous and/or prodromal angina pectoris （AP） on left ventricular function in patients with acute myocardial infarction （AMI）. Methods Selective coronary angiography and left ventriculography were done for 252 patients with first-attack AMI, of whom, 46 had both previous and prodromal AP （group A）, 112 had solely previous AP （group B）, 43 had solely prodromal AP （group C） and 51 had no any history of angina （group D） . The peak creatine kinase, coronary collateral circulation and left ventricular function were analyzed. Results The peak creatine kinase was significantly lower in group A than that in group D （F= 8.17, q= 4.13, P〈0.05）, and the peak creatine kinase MB fraction was significantly lower in group A than those in groups B and D （F=6.52; q=9.14, 3.27; P〈0.05）. The peak creatine kinase MB fractions in groups B and C were significantly lower than that in group D （q= 4.02, 2.95; P〈0.05）. The ratio of non-Q-wave myocardial infarction was significantly higher in group A than that in group D （X^2 =4.74 ,P〈0.05） . The coronary collateral circulation in groups A and B was much better than that in groups C and D （u=2. 284, P〈0.05）. The left ventricular ejection fraction （LVEF） was higher in group A than those in the other groups, the LVEFs in groups B and C were significantly higher than that in group D （F= 13.85, q=3. 52-12. 86, P〈0.05）. The left ventricular wall motion Critina score was lower in group A than those in the other groups （F= 9.36, q= 4. 15- 15.32, P〈0.05）. Conclusion Previous and prodromal angina pectoris could synergetically protect the cardiac function in patients with AMI.

关 键 词：心肌梗死 心绞痛 心室功能 左 

分 类 号：R542.22[医药卫生—心血管疾病]