Mickley H F, Pless P, Nielsen J R, Berning J, Møller M
Kardiologisk afdeling B, Odense Sygehus.
Ugeskr Laeger. 1994 Jan 24;156(4):479-83.
In order to assess the effect of thrombolysis on residual myocardial ischaemia, we prospectively performed maximal exercise testing and ambulatory ST-segment monitoring in a consecutive series of 123 men recovering from a first acute myocardial infarction (AMI). Seventy-four patients fulfilled our criteria for thrombolysis, but only 35 patients received thrombolytic agents, whereas 39 were conservatively treated (controls). In 49 patients thrombolytic therapy was not indicated. Thrombolysis resulted in a non-significant reduction in the prevalence of exercise-induced ST-segment depression: 43% in reperfused patients versus 62% in controls. During 36-hour ambulatory ST-segment monitoring, however, the duration of myocardial ischaemia was significantly reduced in thrombolyzed patients: 322 minutes versus 1144 minutes in controls (p < 0.05). Exercise testing revealed a higher maximal work capacity in thrombolyzed patients compared with controls: 160 +/- 41 versus 139 +/- 34 W (p < 0.02). No difference was found in left ventricular ejection fraction between the two subgroups. We conclude, that thrombolysis given for a first AMI reduces residual myocardial ischaemia. The reduced ischaemic burden is assumed to be the pathophysiologic mechanism underlying the also observed improvement in exercise tolerance.
为了评估溶栓治疗对残余心肌缺血的影响，我们前瞻性地对连续123例首次急性心肌梗死（AMI）恢复中的男性患者进行了极限运动试验和动态ST段监测。74例患者符合我们的溶栓标准，但只有35例患者接受了溶栓药物治疗，39例接受保守治疗（对照组）。49例患者未进行溶栓治疗。溶栓治疗使运动诱发ST段压低的发生率有非显著性降低：再灌注患者为43%，对照组为62%。然而，在36小时动态ST段监测期间，溶栓患者的心肌缺血持续时间显著缩短：对照组为1144分钟，溶栓组为322分钟（p<0.05）。运动试验显示，与对照组相比，溶栓患者的最大工作能力更高：分别为160±41瓦和139±34瓦（p<0.02）。两个亚组的左心室射血分数无差异。我们得出结论，首次AMI进行溶栓治疗可减少残余心肌缺血。缺血负担减轻被认为是运动耐量改善的病理生理机制。
