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目的研究缺血预适应(IP)对接受经皮冠状动脉介入治疗(PCI)的不同年龄急性心肌梗死(AMI)患者保护作用的异同。方法回顾性分析2006年3月至2010年3月190例首次发生AMI患者的临床资料,所有患者在发病12h内进行PCI,按年龄分为老年组(≥60岁,n=105)及成年组(<60岁,n=85),再依据AMI前48h有无心绞痛,各组分为缺血预适应(IP)和非缺血预适应(NIP)2个亚组,分别对各亚组的一般资料、梗死相关血管PCI后血流TIMI分级、再灌注心律失常情况、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTNI)峰值、左心室功能及近期预后进行比较。结果成年患者中,IP亚组的左室射血分数(LVEF)明显高于NIP亚组[(63.7±9.8)vs.(59.1±10.7),P=0.046],IP亚组PCI后梗死相关血管无复流、再灌注心律失常的发生率明显低于NIP亚组(0vs.10.9,P=0.034;2.6vs.15.2,P=0.046),IP亚组CK(1426.5±1312.8)U/L、CK-MB(136.4±128.0)U/L、cTNI(60.0±55.8)μg/L明显低于NIP亚组的(2332.2±1848.4)U/L、(227.2±196.0)U/L、(114.4±108.6)μg/L(P﹤0.05);而老年组2个亚组间上述各指标无显著性差异(P﹥0.05)。结论梗死前心绞痛对成年AMI患者具有心脏保护作用,可改善PCI的预后,而这一效应在老年患者中不明显。
Objective To investigate the protective effect of ischemic preconditioning (IP) on patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) at different ages. Methods The clinical data of 190 first AMI patients from March 2006 to March 2010 were retrospectively analyzed. All patients underwent PCI within 12 hours of onset and were divided into the elderly group (≥60 years, n = 105) and the adult group by age (<60 years old, n = 85) .According to whether there were angina pectoris in 48 hours before AMI, the two groups were divided into two subgroups: ischemic preconditioning (IP) and non-ischemic preconditioning General data, TIMI classification of blood flow after infarction-related vascular PCI, arrhythmia reperfusion, creatine kinase (CK), creatine kinase kinase (CK-MB), cTNI peak, left ventricular function And the recent prognosis comparison. Results Compared with the NIP subgroup, the LVEF in IP subgroup was significantly higher in IP group than that in NIP subgroup [(63.7 ± 9.8) vs. (59.1 ± 10.7), P = 0.046] The incidences of no-reflow and reperfusion arrhythmia were significantly lower than those in the NIP subgroup (0vs.10.9, P = 0.034; 2.6vs.15.2, P = 0.046), IP subgroup CK (1426.5 ± 1312.8) U / (23.2 ± 18.4) U / L, (227.2 ± 196.0) U / L, (114.4 ± 108.6) U / L and (136.4 ± 128.0) U / L and cTNI μg / L (P <0.05). There was no significant difference between the two subgroups in the elderly group (P> 0.05). Conclusion Preinfarction angina has cardioprotective effects on adult patients with AMI, which can improve the prognosis of PCI. However, this effect is not obvious in elderly patients.