缺血预适应和侧枝循环对合并糖尿病的急性心肌梗死患者近期预后的影响

doi:10.3969/j.issn.1006-6233.2018.02.020

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摘要 目的: 探讨心肌缺血预适应(IP)和冠脉侧枝循环(CR)对合并糖尿病的急性心肌梗死患者近期预后的影响。方法: 回顾性分析我院的合并糖尿病的急性心肌梗死患者115例,根据梗死前48h有无心绞痛分为缺血预适应组(IP组,n=69)及无缺血预适应组(NIP组,n=46),两组根据有无侧枝循环(CR)分别分为相应亚组(A组、B组、C组、D组)。分析基线资料、心肌梗死面积、左室射血分数及6个月随访结果,对比两组死亡、严重心律失常、左心功能等不良反应发生情况。结果: A组的CK峰值、CK-MB峰值低于D组(P<0.05)。A组的LVEF高于其他三亚组(P<0.05)。A组患者不良反应发生率低于B组、C组、D组(P<0.05);B组、C组患者不良反应发生率低于D组,差别有统计学意义(P<0.05)。结论: 对于合并糖尿病的急性心肌梗死患者,心肌缺血预适应与侧枝循环,可分别和协同的起到保护梗死心肌及改善近期预后作用。

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关键词 ：心肌缺血预适应, 急性心肌梗死, 侧枝循环

Abstract：Objective: To investigate the effects of myocardial ischemic preconditioning (IP) and coronary collateral circulation (CR) on the short-term prognosis of patients with acute myocardial infarction (AMI) complicated with diabetes mellitus. Methods: Retrospective analysis of diabetic patients with acute myocardial infarction in 115 cases, according to the 48 hours of pre infarction angina pectoris divided into ischemic preconditioning group (IP group, n=69) and non-ischemic preconditioning group (group NIP, n=46). The two groups were divided into subgroups (A group, B group, C group, D group) according to the collateral circulation (CR). The baseline data, myocardial infarct size, left ventricular ejection fraction and 6 months follow-up . The incidence of death, severe arrhythmia, left ventricular function and other adverse reactions were compared between the two groups. Results: The peak value of CK and CK-MB in group A were significantly lower than that in group D(P<0.05). The A in group LVEF was significantly higher than that in other groups(P<0.05). Incidence of adverse reactions of A group was lower than that of B group, C group, D group (P<0.05); B group, C group of patients with adverse reaction rate was significantly lower than that in D group, the difference was statistically significant (P<0.05). Conclusions: In patients with acute myocardial infarction complicated with diabetes mellitus, myocardial ischemic preconditioning and collateral circulation can play a protective role in myocardial infarction and improve the prognosis.

Key words： Myocardial ischemic preconditioning Acute myocardial infarction Collateral circulation

基金资助:山东省卫生厅科研计划项目,(编号:2013WS2761)

通讯作者: 于忠祥

引用本文:

张俊义, 赵凯迪, 马颖, 延荣强, 于忠详. 缺血预适应和侧枝循环对合并糖尿病的急性心肌梗死患者近期预后的影响[J]. 河北医学, 2018, 24(2): 255-258.
ZHANG Junyi, ZHAO Kaidi, MA Ying, et al. Effects of Ischemic Preconditioning and Collateral Circulation on Short-term Prognosis in Patients with Acute Myocardial Infarction Complicated with Diabetes Mellitus. HeBei Med, 2018, 24(2): 255-258.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2018.02.020 或 http://www.hbyxzzs.cn/CN/Y2018/V24/I2/255

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