Castaigne A, Duval-Moulin A M, Dubois-Randé J L, Merlet P
Service de cardiologie, hôpital Henri-Mondor, Créteil.
Arch Mal Coeur Vaiss. 1989 Oct;82 Spec No 3:15-20.
Experimental animal studies have shown that coronary occlusion is followed by myocardial infarction and that coronary reperfusion can limit infarction size. Myocardial necrosis and the recovery of function are progressive phenomena in these animal models. Similarly, human myocardial infarction is caused by coronary occlusion and the size and severity of the infarct can be reduced by spontaneous or therapeutic coronary reperfusion. However, there are important differences between the animal models and clinical myocardial infarction. The results of randomised therapeutic trials of thrombolytic drugs show that the theoretical equation between reperfusion, myocardial protection and reduction of mortality has not yet been fully validated. This may be explained either by the fact that the intermediary criteria of assessment (patency at 90 minutes and ejection fraction at the 3rd week) have been badly chosen or by the fact that some of the therapeutic benefit of thrombolytics on mortality is not due to reperfusion or myocardial protection. The physiopathological rationale behind the use of thrombolytics in the acute phase of myocardial infarction is coronary reperfusion, but is reperfusion beneficial in all myocardial infarcts? What is or are the intermediary factors between reperfusion and the decrease in mortality? Is reperfusion the only benefit of thrombolysis? Clear answers to these questions are not yet available.
实验动物研究表明，冠状动脉闭塞后会发生心肌梗死，而冠状动脉再灌注可限制梗死面积。在这些动物模型中，心肌坏死和功能恢复是渐进性现象。同样，人类心肌梗死由冠状动脉闭塞引起，自发或治疗性冠状动脉再灌注可减小梗死面积和减轻梗死严重程度。然而，动物模型与临床心肌梗死之间存在重要差异。溶栓药物随机治疗试验结果表明，再灌注、心肌保护与死亡率降低之间的理论等式尚未得到充分验证。这可能是由于评估的中间标准（90分钟时的血管通畅情况和第3周时的射血分数）选择不当，或者是由于溶栓药物对死亡率的一些治疗益处并非源于再灌注或心肌保护。在心肌梗死急性期使用溶栓药物背后的生理病理原理是冠状动脉再灌注，但再灌注对所有心肌梗死都有益吗？再灌注与死亡率降低之间的中间因素是什么？再灌注是溶栓的唯一益处吗？这些问题尚无明确答案。
