延迟相缺血预处理心肌保护时间窗的临床探讨  

Selection of cardioprotective timing for the late ischemic preconditioning

作　　者：苏德淳[1] 王珂[1] 范书英[2] 常志文[3] 

机构地区：[1]大连医科大学附属第一医院,辽宁大连116011 [2]北京中日友好医院 [3]首都医科大学附属北京同仁医院

出　　处：《山东医药》2009年第41期4-6,共3页Shandong Medical Journal

基　　金：北京市教育委员会科技发展基金资助项目(KM200610025026)

摘　　要：目的探讨心肌梗死患者延迟相缺血预处理的心肌保护时间窗。方法行直接冠状动脉介入治疗的急性心肌梗死患者150例,根据梗死前心绞痛发作时间分为三组:无心绞痛组(1组)55例,<72 h心绞痛组(2组)55例,>72 h心绞痛组(3组)40例。统计患者一般临床情况、院内预后指标、出院前的左室射血分数,肌酸激酶和肌酸激酶同工酶的曲线下面积反映患者的心肌梗死面积。结果除年龄外,其余各项临床指标在三组间均无统计学差异。2组和3组的心肌梗死面积明显低于1组(P<0.01),但2组的充血性心力衰竭/休克、复合终点发生率明显低于1组和3组(P<0.01或0.05)。梗死前心绞痛的心肌保护作用与年龄、抗心绞痛药物以及侧支循环无关。结论临床缺血预处理的保护时间窗不同于动物实验,可能大于72 h。Objectives To explore the protective timing of the clinical late preconditioning.Methods One hundred and fifty patients of acute myocardial infarction treated by primary percutaneous coronary intervention and divided into three groups：without angina at any time（group 1,n=55）,with preinfarction angina within 72 hours prior to acute myocardial infarction（group 2,n=55）,and with angina out of 72 hours prior to myocardial infarction（group 3,n=40）.Data were collected regarding baseline characteristics,in-hospital outcome,left ventricular ejection fraction before discharge,and myocardial infarct size determined by total creatin kinase and creatin kinase isozyme MB units integrated over the first 24 hours.Results There was no difference in baseline characteristics of patients apart from age.The infarct sizes in the group 2 and group 3 were significantly lower than that in the group 1（P〈0.01）.Patients in the group 2 were less likely to have congestive heart failure/shock and cumulative end-point compared with the group 1（P〈0.01） and the group 3（P〈0.05）.The beneficial effects of preinfarction angina were not dependent on age,antianginal medicines and coronary collaterals.Conclusions The beneficial timing of the late preconditioning is inconsistent with animal experiments,and might be longer than 72 hours.

关 键 词：缺血预处理 心肌 心肌梗死 心绞痛 

分 类 号：R542.2[医药卫生—心血管疾病]