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目的:探讨心肌缺血预适应对急性心肌梗死(AMI)的临床影响。方法:将我院心内科自2012年1月至2013年12月收治的74例首次急性心肌梗死患者按照有无心绞痛史分为心肌缺血预适应组(IP组)和心肌非缺血预适应组(NIP组),经临床常规药物治疗后,观察比较两组患者的心肌酶含量、心肌梗死面积以及主要并发症发生情况。结果:IP组患者的CPK、LDH及AST峰值均显著低于NIP组,两组比较有统计学意义(P<0.01);IP组患者小面积心肌梗死18例,占78.26%,大面积心肌梗死5例,占21.74%,NIP组患者小面积心肌梗死23例,占45.10%,大面积心肌梗死28例,占54.90%,两组比较有统计学意义(P<0.01);IP组心律失常、心衰、心源性休克、再发AMI的发生率显著低于NIP组患者,但IP组患者的梗死后心绞痛发生率高于NIP,两组比较有统计学意义(P<0.01)。结论:IP能够提高心肌自我保护能力,减少心肌梗死面积,改善梗死后的心功能,降低主要并发症的发生几率,为临床治疗AMI提供了新的思路,值得临床深入研究。
Objective: To investigate the clinical effect of myocardial ischemic preconditioning on acute myocardial infarction (AMI). Methods: The 74 patients with acute myocardial infarction admitted to our hospital from January 2012 to December 2013 were divided into preconditioning group (IP group) and non-ischemic preconditioning group according to the history of angina pectoris Group (NIP group). After clinical routine drug treatment, the myocardial enzyme content, myocardial infarction area and the incidence of major complications in two groups were observed and compared. Results: The peak values of CPK, LDH and AST in IP group were significantly lower than those in NIP group (P <0.01). IP group had 18 cases of small area myocardial infarction (78.26%), large area myocardial infarction 5 cases, accounting for 21.74%. There were 23 cases of small area myocardial infarction in NIP group (45.10%), 28 cases of large myocardial infarction (54.90%), the two groups had statistical significance (P <0.01) The incidence of heart failure, cardiogenic shock and recurrent AMI was significantly lower in patients with NIP than those in NIP. However, the incidence of post-infarction angina in IP group was higher than that of NIP (P <0.01). Conclusion: IP can improve myocardial self-protection, reduce myocardial infarct size, improve cardiac function after infarction and reduce the incidence of major complications, which provides a new idea for the clinical treatment of AMI and deserves clinical in-depth study.