缺血后处理对急性心肌梗死患者介入治疗后心肌组织水平灌注的影响  

Effects of ischemic postconditioning on myocardial tissue perfusion in patients underwent primary percutaneous coronary intervention

作　　者：张兴华[1] 马晓静[1] 李春梅[1] 张绪洪[1] 吕政[1] 苑海涛[1] 于厚志[1] 张玉英[1] 

机构地区：[1]山东大学山东省立医院心内科,济南250021

出　　处：《中华急诊医学杂志》2007年第4期362-365,共4页Chinese Journal of Emergency Medicine

基　　金：山东省医药卫生科研基金资助项目（2003HZ105）;山东省自然科学社会资助项目（Y2005C70）.

摘　　要：目的研究缺血后处理对急性心肌梗死患者介入治疗后冠状动脉血流速度及预后的影响。方法选取12h内接受急诊冠状动脉介入治疗的心肌梗死患者92例，分为两组：单纯再灌注组和缺血后处理组，测定校正TIMI帧数（CtTC）、血肌酸磷酸激酶（CK）、肌酸磷酸激酶同工酶（K-MB）、丙二醛（MDA），术后8周测定室壁运动记分。结果缺血后处理组CTFC明显高于单纯再灌注组[（25．38±5．35）vs 29．23±5．54，P〈0．05]；CK与CK-MB峰值明显低于单纯再灌注组[（1236．57±813．21）U／L vs （1697．36±965．74）U／L，P〈0．05；（116．92±75．83）U／L vs （172．41±92．64）U／L，P〈0．05]；缺血后处理组术后各时点MDA水平均低于单纯再灌注组。术后8周缺血后处理组室壁运动恢复优于单纯再灌注组[（1．20±0．22）vs（1．32±0．25），P〈0．05）]。结论缺血后处理可以改善介入治疗后冠状动脉血流速度，减少自由基的生成，改善心功能。Objective To observe the effect of postconditioning on coronary blood flow velocity and prognosis in patients with acute myocardial infarction who underwent primary percutaneous coronary intervention （PCI）. Method Ninety-two patients with acute myocardial infarction who underwent revascularization within 12 h of onset by primary PCI were recruited in the study. All the patients were randomized into two groups ： ischemiareperfuaion （IR） group and postconditioning （Postcon） group. Corrected TIMI frame count （CTFC） was used to evaluate the velocity of coronary blood flow after PCI. Creatine phosphokinase （CK）, CK-MB and malondialdehyde （MDA） were measured before and after PCI. Wall motion score index （WMSI） was assessed by two-dimensional echocardiography before and 8 weeks after PCI. Results Patients of Postcon group had much faster CTFC than that of IR group [ （25.38 ± 5.35） vs （29.23 ± 5.54）, P 〈 0.05）]. The peaks of CK and CK-MB of Postcon group were much lower than that of IR group （ （1236.57 ± 813.21） U/L vs （1697.36 ± 965.74） U/L, P 〈 0.05; （116.924 ± 75.83） U/L vs （172.41 ± 92.64） U/L, P 〈 0.05）1 and MDA-reactive products were significantly lower than that in the IR group at any same time after PCI. The WMSI of Postcon group was much lower than that of IR group [ （1.20±0.22） vs （1.324±0.25）, P〈0.05）]. after 8 weeks. Conclusions Isehemia posteonditioning would improve the velocity of coronary blood flow and cardiac function after PCI through decreasing the production of oxygen free radicals.

关 键 词：后处理 缺血 再灌注 急性心肌梗死 

分 类 号：R686[医药卫生—骨科学]