Glazier J J, Piessens J
University Hospital Gasthuisberg, Leuven, Belgium.
J R Coll Physicians Lond. 1991 Apr;25(2):102-4.
The mechanisms responsible for the frequent absence of pain during episodes of acute myocardial ischaemia are poorly understood. The severity and duration of ischaemia are inadequate predictors of painless ischaemia, and thus it appears likely that important additional mechanisms must be involved. One such mechanism that may be operating in some patients is a generally deficient perception of painful stimuli. Destruction of afferent nerve fibres subserving cardiac nociception is a relevant consideration in some patients with diabetes mellitus and silent ischaemia. Psychological factors may also, in some patients, be important in modulating the ischaemic stimulus. The role of endorphins in the perception of cardiac ischaemic pain is uncertain. It is unlikely that the mechanisms responsible for painless myocardial ischaemia vary from patient to patient and even within the same patient from week to week or from day to day.
急性心肌缺血发作时频繁无痛的原因尚未完全明确。缺血的严重程度和持续时间并不能充分预测无痛性缺血，因此很可能还涉及其他重要机制。在一些患者中可能起作用的一种机制是对疼痛刺激的普遍感知不足。在一些糖尿病和无症状性缺血患者中，支配心脏伤害感受的传入神经纤维受损是一个相关因素。在一些患者中，心理因素在调节缺血刺激方面也可能很重要。内啡肽在心脏缺血性疼痛感知中的作用尚不确定。导致无痛性心肌缺血的机制不太可能因患者而异，甚至在同一患者体内，每周或每天也有所不同。
