渐进缺血后适应对经皮冠状动脉介入术患者心脏的保护作用  

Cardioprotective effects of gradual ischemic postconditioning in percutanous coronary intervention

作　　者：于宗良[1] 许浩军[1] 朱建中[1] 顾明[1] 王俊锋[1] 周伟伟[1] 汪强[1] 谷惠敏[1] 

机构地区：[1]昆山市第一人民医院,江苏大学附属昆山医院心血管内科,江苏昆山215300

出　　处：《中国中西医结合急救杂志》2015年第4期390-393,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：江苏省昆山市科技计划项目（KS1002）;江苏大学医学临床科技发展基金（JLY20140059）

摘　　要：目的探讨直接经皮冠状动脉（冠脉）介入术（PPCI）中渐进缺血后适应（IP）再灌注对ST段抬高型急性心肌梗死（STEAMI）再灌注损伤的保护作用。方法选择2011年2月至2014年8月在江苏昆山市第一人民医院、江苏大学附属昆山医院心内科住院行PPCI的STEAMI患者102例，将患者按随机数字表法分为IP组32例、渐进IP组30例、常规再灌注组40例。IP组开通梗死相关血管后，通过预扩张球囊充盈／撤压时间为1min／1min，循环3次，然后予以持续再灌注；渐进IP组实施IP的时间呈渐进变化，即在3次球囊充盈／撤压时间分别为1min／1min、30s／30s、15s／15s；常规再灌注组闭塞血管开通后持续恢复冠脉供血。比较3组相关导联再灌注心律失常发生率、ST段回落率、校正心肌梗死溶栓治疗（TIMI）帧数（CTFC）、肌酸激酶同工酶（CK—MB）峰值、左室射血分数（LVEF）的变化，并随访不良事件的发生情况。结果3组基线资料均衡，有可比性。渐进IP组频发室性期前收缩（室早）发生率明显低于常规再灌注组[30．0％（9／30）比55．0％（22／40），P〈0．05]，IP组[34．4％（11／32）]室早发生率虽低于常规再灌注组，但差异无统计学意义（P〉0．05）。IP组和渐进IP组室性心动过速（室速）发生率明显低于常规再灌注组[15．6％（5／32）、13．3％（4／30）比40．0％（16／40），均P〈0．05]。IP组、渐进IP组心室纤颤、心动过缓、窦性停搏的发生率均低于常规再灌注组，但差异均无统计学意义（均P〉0．05）。IP组、渐进IP组ST段回落率、CTFC、CK—MB峰值均明显低于的常规再灌注组[ST段回落：（56．7±18．3）％、（57．3±21．5）％比（44．6±21．6）％；CTFC（帧）：25．47±5．37、24．46±6．41比31．62±7．56；CK—MB峰值（U／L）：126．3±78．5、121．6±82．5比147．4±72．5；均P〈0．05]，且以渐进IP组作用�Objective To observe the protective effect of gradual ischemic postconditioning （IP） capable of improving reperfusion on reperfusion injury in patients with ST-segment elevation acute myocardial infarction （STEAM1） undergoing primary percutaneous coronary intervention （PPCI）. Methods 102 in-patients with STEAMI undergoing PPCI in the Department of Cardiology in the First People＇s Hospital of Kunshan City Affiliated to Jiangsu University from February 2011 to August 2014 were enrolled in this study. They were divided into three groups by a random number table： IP group （32 cases）, gradual IP group （30 cases） and routine reperfusion group （40 cases）. In IP group, after the opening of the infarction related blood vessel, ischemic postconditioning within the first minute of arterial reperfusion was made through three episodes of 1 minute inflation and 1 minute pressure withdrawn of an angioplasty balloon, and then persistent reperfusion was carried out. In the gradual IP group, the patients received three times of gradual angioplasty balloon inflation and denation, 1 minute/lminute, 30 seconds/30 seconds and 15 seconds/15 seconds respectively, presenting the gradual change of IP time. In the routine reperfusion group, after the opening of blocked blood vessel, the patients underwent routine PCI to persistently recover the coronary artery blood supply. The changes of related lead ST segment regression （Sum-STR）, incidence of reperfusion arrhythmia, corrected thrombolysis in myocardial infarction （TIMI） franle count （CTFC）, peaks of MB isoenzyme of creatine kinase （CK-MB）, left ventricular ejection fraction （LVEF） and frequency of adverse events in follow-up period were compared among the three groups. Results The baseline characteristics were comparable in three groups. The incidence of ventricular premature beats was significantly lower in gradual IP group than that in routine reperfusion group [30.0% （9/30） vs. 55.0% （22/40）, P 〈 0.05], and although the incid

关 键 词：缺血后适应 渐进 血管成形术 直接经皮冠状动脉介入 

分 类 号：R541.4[医药卫生—心血管疾病]