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目的 探讨既往和发病前心绞痛对急性心肌梗死 (AMI)后左室功能的近期影响。方法行选择性冠状动脉造影和左室造影的 2 52例首次急性心肌梗死患者 ,分组比较既往心绞痛及发病前心绞痛对肌酸激酶 (CK)峰值浓度、冠状动脉侧支循环和左室功能等的影响。结果 (1 )分组 :2 52例患者中 ,兼有既往心绞痛和发病前心绞痛者 46例 (A组 ,占 1 8 3 % ) ,单纯既往心绞痛者 1 1 2例 (B组 ,占 44 4% ) ,单纯发病前心绞痛者 43例 (C组 ,占 1 7 1 % ) ,梗死前无心绞痛者 51例 (D组 ,占 2 0 2 % ) ;(2 )CK峰值浓度 :A组显著低于D组 (P <0 0 5) ;肌酸激酶同工酶 (CK MB)的峰值浓度A组显著低于D组 (P <0 0 1 )和B组 (P <0 0 5) ,B组和C组均低于D组 (P均 <0 0 5)。 (3)非Q波心梗的比率 :A组显著高于D组 (35 %与 1 6 % ,P <0 0 5)。 (4)冠状动脉侧支循环 :有既往心绞痛的A、B组明显好于既往无心绞痛的C、D组 (P <0 0 5)。 (5)左室射血分数 :A组显著高于其他各组 ,而且B组和C组均高于D组 (P <0 0 5)。 (6)室壁运动Cortina计分 :A组明显低于其他各组 ,B组和C组均显著低于D组(P <0 0 5)。结论 既往心绞痛促进冠状动脉侧支循环的建立 ,发病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
Objective To investigate the short-term impact of previous and pre-angina pectoris on left ventricular function after acute myocardial infarction (AMI). Methods A total of 522 patients with first acute myocardial infarction undergoing selective coronary angiography and left ventricular angiography were divided into two groups according to the peak concentrations of creatine kinase (CK), coronary collateral circulation and left ventricular function influences. Results (1) Grouping: Of the 525 patients, 46 had both previous angina and pre-angina pectoris (group A, 18.3%), 112 had simple angina pectoris (group B, 44.4% ), 43 patients with simple pre-angina pectoris (group C, 17.1%), 51 patients without pre-infarction angina pectoris (group D, 202%); (2) CK peak concentration: The peak concentration of creatine kinase MB in group A was significantly lower than that in group D (P <0 0 1) and group B (P 0 05) and group B And C group were lower than the D group (P <0.05). (3) The ratio of non-Q wave MI: A group was significantly higher than D group (35% vs 16%, P <0 05). (4) coronary collateral circulation: with previous angina pectoris group A, B was significantly better than the previous group of angina pectoris C, D (P <0 05). (5) Left ventricular ejection fraction: A group was significantly higher than the other groups, and the B group and C group were higher than the D group (P <0 05). (6) The Cortina score of wall motion was significantly lower in group A than in other groups, while group B and group C were significantly lower than group D (P <0.05). CONCLUSIONS: Previous angina pectoris promoted the establishment of coronary collateral circulation. Pre-onset angina pectoris may result in ischemic preconditioning. Both of them can cooperate to protect cardiac function after acute myocardial infarction