再灌注预处理对急性心肌梗死患者的影响  

Effect of reperfusion preconditioning on acute myocardial infarction

作　　者：李德[1] 唐兵[1] 速晓华[1] 马双陶[1] 李刚[1] 陈劲松[1] 杨大春[1] 朱峻[1] 杨永健[1] 

机构地区：[1]成都军区总医院心血管内科,成都市610083

出　　处：《中华实用诊断与治疗杂志》2012年第10期989-990,共2页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的探讨急诊经皮冠状动脉介入术(percutaneous coronary intervention,PCI)治疗时再灌注预处理对急性心肌梗死患者的影响。方法 87例急性心肌梗死患者行急诊PCI时,45例于支架植入前行低流量灌注10min(预处理组),42例直接行球囊扩张和支架植入(对照组)。观察2组支架植入后罪犯血管无复流发生率、再灌注心律失常、心肌损伤标志物水平和心功能变化。结果预处理组支架植入后罪犯血管无复流发生率(6.7%)低于对照组(16.7%)(P<0.01),术中及术后2h内再灌注心律失常发生率(24.4%)低于对照组(40.1%)(P<0.01),血清肌酸激酶同工酶峰值(52.5±19.4)μg/L低于对照组(66.8±22.9)μg/L(P<0.05),术后第7天左心室射血分数(55±12)%高于对照组(48±13)%(P<0.05)。结论急性心肌梗死患者行急诊PCI时采用低流量灌注进行再灌注预处理可减少心肌再灌注损伤,提高治疗效果。Objective To evaluate the effect of reperfusion preconditioning on the patients with acute myocardial infarction （AMI） during primary percutaneous coronary intervention （PCI）. Methods A total of 87 patients with AMI receiving primary PCI were divided into preconditioning group （n=45） receiving preconditioning with low-flow perfusion for 10 minutes before stent implantation, and control group （n=42） directly receiving balloon dilatation and stent implantation without preconditioning. The incidences of no-reflow, reperfusion arrhythmias, myocardial injury marker levels and cardiac function were recorded after stent implantation. Results The incidence of no-reflow was significantly lower in preconditioning group （6.7%） than that in control group （16. 7%） （P〈0.01）. The incidence of reperfusion arrhythmias was significantly lower in preconditioning group （24. 4 %） than that in control group （40. 1 % ） during PCI and 2 hours after PCI （P〈0.01）. The creatine kinase-myocardial band peak was （52.5±19.4） ug/L in preconditioning group significantly lower than that in control group （66.8±22.9） ug/L （P〈0.05）. The left ventricular ejection fraction was significantly higher in preconditioning group （0.55±0.12） than that in control group （0.48±0.13） 7 days after PCI （P〈0.05）. Conclusion During primary PCI, reperfusion preconditioning with low-flow perfusion can reduce myocardial reperfusion injury, and enhance the therapeutic effect.

关 键 词：急性心肌梗死 经皮冠状动脉介入治疗 再灌注预处理 

分 类 号：R542.22[医药卫生—心血管疾病]