缺血后适应对急性心肌梗死急症介入治疗患者心肌灌注及预后的影响  

Effects of ischemic postconditioning on myocardial perfusion and prognosis in patients with acute myocardial infarction treated with emergency percutaneous coronary intervention

作　　者：黄文军[1] 闫博宇[1] 叶君明[1] 周国忠[1] 荣德爱[1] 李莺[1] 

机构地区：[1]江西省萍乡市人民医院心血管内科,337055

出　　处：《介入放射学杂志》2015年第7期571-574,共4页Journal of Interventional Radiology

基　　金：江西省卫生厅科技项目(20143278)

摘　　要：目的探讨缺血后适应(IPOC)对急性ST段抬高型心肌梗死(STEMI)急症经皮冠状动脉介入治疗(PCI)患者心肌灌注和预后的影响。方法 203例接受急症PCI治疗的STEMI患者随机分为IPOC组(n=103)和对照组(n=100),IPOC组在再灌注开始1 min内行IPOC处理,对照组在再灌注后最初6 min内不作干预。观察两组患者心肌肌钙蛋白I(c Tn I)峰值、肌酸激酶同工酶(CK-MB)峰值、左室射血分数(LVEF)、室壁运动评分指数(WMSI)、校正的TIMI计帧(CTFC)及住院期间主要心血管不良事件(MACE)有无差异。结果两组患者在年龄、性别、危险因素、梗死相关血管、缺血时间等方面差异均无统计学意义(P>0.05);IPOC组CTFC明显快于对照组[(25.3±7.9)帧对(29.4±8.4)帧(P<0.05)];IPOC组CK-MB峰值、c Tn I峰值明显低于对照组[(157.3±83.6)U/L对(201.5±77.3)U/L,(2.5±1.3)ng/ml对(3.1±1.0)ng/ml)(P<0.05)];两组患者入院时LVEF、WMSI均无统计学差异,术后3个月IPOC组LVEF、WMSI均明显优于对照组[(57.4±8.7)%对(53.6±9.3)%,1.19±0.4对1.27±0.3(P<0.05)]。IPOC组术后3个月MACE发生率明显低于对照组(P<0.05)。结论 IPOC能够改善STEMI急症PCI治疗患者冠状动脉血流,减轻心肌细胞缺血-再灌注损伤,改善心功能及预后。Objective To investigate the effects of ischemic postconditioning（IPOC） on myocardial perfusion and prognosis in patients with acute ST- segment elevation myocardial infarction（STEMI） who were treated with emergency percutaneous coronary intervention（PCI）. Methods A total of 203 patients with STEMI who received emergency PCI were randomly divided into IPOC group（n=103） and control group（n=100）. For the patients of IPOC group the angioplasty balloon was re- inflated within one minute after the beginning of reperfusion, the procedure was repeated three times, each time the inflation of balloon lasted for1 minute using low- pressure（4-6 atm）, and the interval between the inflation procedures was one minute. For the patients of the control group, no additional intervention was employed during the first 6 minutes of reperfusion. Cardiac troponin I（c Tn I） peaks, creatine kinase- MB（CK-MB） peaks, left ventricular ejection fraction（LVEF）, wall motion score index（WMSI）, corrected thrombolysis in myocardial infarction（TIMI）frame count（CTFC）, and major adverse cardiac events（MACE） occurred during hospitalization time in both groups were recorded and the results were compared between the two groups. Results No significant differences in age, sex, risk factors, infarction- related artery, ischemia time, etc. existed between the two groups（P0.05）. The CTFC values of IPOC group were significantly faster than those of the control group, that was（25.3 ±7.9） vs.（29.4±8.4）,（P0.05）. The CK-MB peak and c Tn I peak values of IPOC group were remarkably lower than those of the control group, those were（157.3 ±83.6） U/L vs.（201.5 ±77.3） U/L and（2.5 ±1.3） ng/m L vs.（3.1 ±1.0） ng/m L respectively（P 0.05）. At the time of admission, there were no significantly differences in the LVEF and WMSI values between the two groups, and three months after PCI the LVEF and WMSI values of IPOC group were significantly better than those of the control group, th

关 键 词：急性心肌梗死 经皮冠状动脉介入 缺血后适应 主要心血管事件 

分 类 号：R542.22[医药卫生—心血管疾病]