摘要目的 观察warm-up现象对缺血心脏的保护及钾通道阻滞剂的影响.方法 慢性稳定性心绞痛患者根据其是否合并糖尿病及其处理方式分为对照组25例;格列本脲(DMG)组22例,合并糖尿病并服用格列本脲患者;节食对照(DMD)组25例,合并糖尿病以节食方式血糖控制达标者.分别进行间隔15 min的连续2次踏车运动试验(EX1,EX2),观察运动时间(ED)、出现ST段压低0.1 mV时间(T-STD)、ST段压低的最大值(STDmax)以及ST段压低0.1 mV时的心率收缩压乘积(RPP)等指标.结果 对照组两次运动相比ED和T-STD延长[(546.04±103.78)s比(617.52±106.96)s,P<0.05]和[(378.64±92.34)s比(436.84±91.25)s,P<0.05];STDmax减轻[(2.06±0.37)mm比(1.75±0.41)min,P<0.01],RPP提高[(173.77±34.73)次·min~(-1)·min Hg~(-2)比(199.23±37.07)次·min~(-1)·mm Hg~(-2),P<0.05];DMG组除了T-STD延长[(328.45±64.66)s比(363.00±81.48)s,P<0.01]外,其余各指标均无明显变化(P>0.05);DMD组两次运动各指标变化趋势与对照组相似.结论 运动可以诱发慢性稳定性心绞痛患者发生warm-up现象;钾通道阻滞剂格列本脲能够阻断其发生.

abstractsObjective To explore the protection for ischemic myocardium with warm-up phenomenon and KATP channel blocker interventional effect on it. Methods Patients with chronic stable angina who came into the study were divided into three groups according to the presence of diabetes and its treatment ways: 25 patients without diabetes came into a NDM group, 22 patients with diabetes treated with glibenclamide came into a DMG group and 25 patients with diabetes but on diet only came into a DMD group. All the patients underwent sequential bicycle ergnmeter exercise test twice (EX1, EX2)with a time interval of 15 min. Parameters including exercise duration (ED), time for 1 mm ST-segment depression (T-STD), maximum STD (mm) and corresponding heart-rate systolic blood pressure product (RPP) were observed respectively. The parameters obtained during EX2 were compared with those obtained during EX1.Results In the group NDM,ED and T-STD were prolonged [(546. 04±103.78)s vs (617.52±106. 96) s, P < 0.05 and (378.64±92.34)s vs (436.84±91.25)s, P<0.05], STDmax was shortened [(2.06± 0.37) mm vs(1.75±0.41)mm,P<0.01]and RPP was increased[(173.77±34.73) beats±min~(-1)·nun Hg~(-2) vs (199.23±37.07 beats·min~(-1)·mm Hg~(-2), p<0.05]as the parameters during EX2 were compared with those during EX1. In the group DMG, there was no difference in these analysed parameters except that T-STD was prolonged [(328.45±64.66)s vs (363.00±81.48)s, P<0.01]when these of EX2 and EX1 were compared. In the group DMD,all the analysed parameters improved significantly during the second test (EX2) in comparison with the first test (EX1) as the results in the group NDM. Conclusions Exercise test can induce warm-up phenomenon in patients with chronic stable angina poctoris.The KATP channel blocker glibenclamide can block the warm-up phenomenon.