缺血后处理改善急诊介入治疗术后心肌灌注的研究  

A benefit of ischemic postconditioning during primary percutaneous coronary intervention in acute ST-elevation myocardial infarction

作　　者：范民忠 郭方明[2] 王效浣[3] 范觉新[2] 赵岚[2] 

机构地区：[1]烟台市烟台山医院影像科,山东省264001 [2]烟台市烟台山医院心内科,山东省264001 [3]甘肃省人民医院心内科

出　　处：《中华临床医师杂志（电子版）》2012年第17期5108-5111,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：烟台市科技发展项目(2011230)

摘　　要：目的观察缺血后处理对急性ST段抬高心肌梗死的老年患者急诊经皮冠状动脉介入治疗后再灌注心肌的影响。方法 62例急诊PCI患者(>60岁)入选,随机分为研究组(缺血后处理组,n=32)和对照组(n=30),前者应用缺血后处理技术,即开通梗死相关动脉1 min后,用球囊扩张30 s,回抽30 s,循环3次;对照组再灌注3 min内不给予任何处理。测定术后梗死相关动脉TIMI分级、校正TIMI帧数、MBG及心电图ST段回落评估术后冠状动脉血流。检测术后5～7 d射血分数,观察住院期间主要不良心血管事件。结果两组年龄、发病至球囊时间及冠心病危险因素等基本情况无统计学差异;病变血管支数、病变长度、抽吸导管应用两组比较也无显著性差异。梗死相关动脉血流参数:TIMI 3级比例研究组高于对照组(P=0.036),平均校正TIMI帧数低于对照组(P=0.002);梗死区心肌灌注参数:心肌显影3级和ST段回落百分比≥70%研究组高于对照组(P=0.043和0.029),术后肌酸激酶低于对照组(P=0.028);心功能指标:左心室射血分数研究组高于对照组(P=0.042),有统计学差异。住院期间主要心血管事件发生率,虽未达到显著性统计学意义水准,研究组有低于对照组的趋势(P=0.075)。结论缺血后处理减轻再灌注损伤,增加心肌灌注,改善急性心肌梗死近期预后。Objective To examine the effects of postconditioning in old patients with acute ST-elevation myocardial infarction(ASTEMI)undergoing primary PCI.Methods 62 patients(>60 years)with their first ASTEMI were randomly assigned to a study group(n=32)or control(n=30)within 90 minutes after admission.After predilatation,in the control group,no intervention was applied in the first 3 minutes of reperfusion,while in the study group(postconditioning group),three cycles of 30-second angioplasty balloon deflation and 30-second inflation were repetitively applied.TIMI,corrected TIMI frame count and resolution of maximal ST-segment elevation were calculated before and after PCI,and left ventricular ejection fraction(LVEF)was detected by echocardiography 5-7 days after PCI.Major adverse cardiovascular events(MACE)were tracked during in-hospital following-up.Results There were no significant differences in clinical and lesion characteristics between two groups.The numbers of final TIMI flow 3,myocardial blush grade 3 and ST segment resolution≥70% in study group were much more that those in control,and the TIMI frame counts were lower and LVEF increased higher in the study group compared to control.There was a trend toward MACE in the postconditioning group compared to that in the control group.Conclusions This study demonstrates that postconditioning following PCI,significantly protecting the heart against ischemia/reperfusion-induced injury,would be improve the prognosis of ASTEMI.

关 键 词：心肌梗死 血管成形术 经腔 经皮冠状动脉 再灌注损伤 缺血后处理 

分 类 号：R542.22[医药卫生—心血管疾病]