心肌缺血预适应对急性心肌梗死患者溶栓治疗效果的影响研究  

Clinic study on the efficacy of thrombolytic therapy on acute myocardial infarction after ischemic preconditioning

作　　者：尤华彦[1] 曹华明[1] 王强[1] 陈茂华[1] 张煜[1] 冯健 羊镇宇[1] 

机构地区：[1]南京医科大学附属无锡市人民医院心内科,江苏省无锡市214023

出　　处：《中华全科医学》2015年第12期1918-1920,共3页Chinese Journal of General Practice

基　　金：江苏省自然科学基金(BK2012100)

摘　　要：目的及时恢复缺血区的血液灌注即再灌注是临床上挽救缺血心肌的最有效措施,但再灌注会引起严重的再灌注损伤。心肌缺血预适应(IP)可以减轻缺血再灌注损伤后心肌的坏死与心肌功能障碍。本文通过临床研究,分析探讨IP患者的临床指标变化及患者预后,观察其对急性心肌梗死(AMI)患者溶栓治疗效果的影响。方法本研究选取2011年1月—2014年12月收住入院的初发AMI患者222例,分为IP组120例及非IP组102例。2组患者皆给予尿激酶150万U+生理盐水100 ml,于30 min内静脉滴入,6 h后给予低分子肝素5000 U,12 h一次,连用7 d。其他药物据情况而定,比较2组患者磷酸肌酸激酶同工酶(CK-MB)、肌钙蛋白T(CTnT)峰值、左室射血分数(LVEF)、冠状动脉再通率及再通时间;以及住院期间心力衰竭、严重心律失常、心源性休克、梗死后心绞痛发生率和近期病死率。计量资料用t检验,数据用(x±s)表示,计数资料用χ2检验,数据用百分比表示。结果 IP组CK-MB、CTnT峰值比非IP组低[(112±89)U/L,(2.5±1.7)ng/ml vs.(138±93)U/L,(3.4±2.5)ng/ml],差异有统计学意义(P<0.05)。IP组比非IP组的左室射血分数高[(51.2±12.4)%vs.(43.7±13.9)%],差异有统计学意义(P<0.05)。IP组的冠状动脉再通率比非IP组高[85.0%(102/120)vs.65.7%(67/102)]及再通时间皆比非IP组短[(4.12±1.38)h vs.(5.01±1.21)h],差异有统计学意义(P<0.05)。预后及病死率方面,IP组的住院期间心力衰竭、严重心律失常、心源性休克和梗死后心绞痛发生率均较非IP组低(P<0.05)。结论有心肌缺血预适应的AMI患者进行尿激酶静脉溶栓治疗的效果较无心肌缺血预适应者更优,心肌缺血预适应对心肌有保护作用。Objective To restore the blood perfusion in the ischemic region is the most effective measure to save the ischemic myocardium,but it can cause severe reperfusion injury. Myocardial ischemic preconditioning（ IP） can reduce the myocardial necrosis and myocardial dysfunction after ischemia reperfusion injury. This experiment through clinical research,analysis of myocardial ischemia pre adaptation（ IP） in patients with clinical index changes and the prognosis of the patients to observe its impact on the effect of thrombolytic therapy on patients with acute myocardial infarction（ AMI）.Methods Total 222 patients hospitalized from January 2011 to December 2014 were included in this study. All the patients were divided into ischemic preconditioning group（ IP group） of 120 patients and non ischemic preconditioning group（ non-IP group） of 102 patients. Both group were treated with Urokinase for thrombolytic therapy（ Treated with urokinase150 million U ＋ normal saline 100 ml,within 30 min intravenous infusion and 6 h after given low molecular weight heparin 5000 U,12 h time,q. d. for 7 days. Other drugs according to the circumstance）. The The peak value of creatine kinase isoenzyme（ CK-MB）,Cardiac Troponin T（ CTnT）,Left ventricular ejection fraction（ LVEF）,reperfusion rate and reperfusion time were compared. Also the Heart failure,severe arrhythmia,cardiac shock,the incidence of angina pectoris and the recent mortality rate were recorded and compared. Measurement data using t test,the data with mean ＋ standard deviation（ x ± s） said,count data using chi square test,data with percentage said. Results The peak of CK-MB（ U / L）,CTnT（ ng/ml） of IP group were lower than that in the non-IP group（ 112 ± 89,2. 5 ± 1. 7 vs. 138 ± 93,3. 4 ± 2. 5）,there was statistically significant difference（ both P〈0. 05）. LVEF of IP group was higher than that in non-IP group（ 51. 2% ±12. 4% vs. 43. 7% ± 13. 9%）,it has statistically significant difference（ P〈0. 05）. Repe

关 键 词：心肌缺血预适应 心肌梗死 尿激酶 

分 类 号：R544.22[医药卫生—心血管疾病]