缺血后处理对急性心肌梗死患者冠脉血流的影响  

Impact of Ischemic Postconditioning on Myocardial Reperfusion in Patients with Acute ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

作　　者：吴志国[1] 李广平[2] 张正浩 曹艳君[1] 张红雨[1] 仇宝华[1] 王淑静[1] 梅莲莲[1] 张霞[1] 翟建涛[1] 张玉新[4] 

机构地区：[1]天津医科大学宝坻临床学院心内科,天津市301800 [2]天津医科大学第二医院心内科 [3]哈特福德医院内科 [4]天津医科大学宝坻临床学院放射科

出　　处：《医学理论与实践》2013年第8期987-990,共4页The Journal of Medical Theory and Practice

摘　　要：目的:观察缺血后处理(ischemic postconditioning,IPC)对接受直接经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(ASTEMI)患者冠脉血流的影响。方法:发病12h内且接受直接PCI治疗的ASTEMI患者106例,随机分为对照组(行标准PCI操作)和缺血后处理组(在标准PCI操作基础上于梗死相关动脉再通后给予3轮30s/次的缺血后处理)。观察术中冠脉血流情况、术后心肌坏死标志物及炎症标志物水平。结果:两组患者基线临床情况、冠脉病变及PCI治疗情况一致,缺血后处理组术中无复流(NRF)发生率低于对照组(8.0%VS 23.2%,P=0.033);ST段完全回落率高于对照组(96.0%VS 83.9%,P=0.042);尽管术毕时梗死相关动脉TIMI血流无差异,但CTFC及Blush血流好于对照组(P<0.05);缺血后处理组术后CK-MB和高敏肌钙蛋白T(Hs-TnT)均低于对照组[(258.3±87.8)U/L VS(306.6±94.4)U/L,P=0.008;(3 582.08±1 731.40)ng/L VS(4 501.34±1 554.4)ng/L,P=0.005]。同样,术后缺血后处理组的高敏C反应蛋白(Hs-CRP)水平亦低于对照组[(29.25±46.13)mg/L VS(32.20±43.50)mg/L,P=0.048]。结论:3轮30s/次的缺血后处理可以通过减轻缺血再灌注损伤降低ASTEMI患者术中NRF发生率。Objective： No-reflow （NRF） limits the clinical outcomes of patients with acute ST elevation myocardial infarction（ASTEMI） undergoing primary pereutaneous coronary intervention （PCI）. This randomized controlled study was designed to evaluate the immediate protective effects of ischemic postconditioning pretreatment on myocardial perfusion and myocardial ischemic injury during primary PCI. Methods： 106 patients with ASTEMI were randomly assigned to assigned to either a control（n=56） or a postconditioning（n= 50） group. After reperfusion by direct PCI, control subjects underwent no further intervention, whereas posteonditioning was performed within 30 seconds of reflow by 3 episodes of 30 seconds inflation and 30 seconds deflation of the angioplasty balloon. Thrombolysis in myocardial infarction （TIMI） flow grade, corrected TIMI frame count （CTFC） and myocardial blush grade of the intervened vessel were recorded before and after stent deployment. NRF was defined as a TIMI flow grade 〈3. Creatine kinase isoenzyme MB （CK-MB）, high sensitivity troponin T（Hs-TnT） and plasma level of high sensitivity-C reactive protein （hs-CRP） were measured before and after the procedure. Results. The NRF during PCI was significantly decreased in the postconditioning group than in the control group （8. 0% VS 23. 2%,P=0. 033）. After PCI, there was no difference in TIMI flow grade in the two group, but the CTFC was lower in the postconditioning group than in the control group （24. 8±1.4 VS 25. 5±1.4,P=0. 014）. Myocardial blush grade was also improved in the postconditioning group than in the control group （P〈0.05）. Although PCI caused a significant increase in CK-MB after the procedure, the peak CK-MB value was lower in the postconditioning group than in the control group[（258. 3±87. 8）U/L VS （306. 6±94. 4）U/L,P= 0. 008]. Similar changes were also found in Hs-TnT[（3 582. 084-±1 731. 40）ng/L VS （4 501. 34±1 554. 4）ng/L,P= 0.005land hs-CRP[（29. 25±46. 13）m

关 键 词：缺血后处理 急性心肌梗死 无复流 血管成形术 经腔 经皮冠状动脉 

分 类 号：R542.22[医药卫生—心血管疾病]