缺血后适应对急性心肌梗死患者PCI术后心功能及预后的影响  

Effect of ischemic postconditioning on cardiac function and prognosis in patients with acute myocardial infarction undergoing percutaneous coronary intervention

作　　者：唐方明[1] 李鸿杰[1] 敖伟[1] 王格社[1] 陈冠鹏[1] 叶丽冰[1] 吴聪聪[1] 包浔娜[1] 何星球[1] 郑云龙[1] 

机构地区：[1]广东省农垦中心医院,广东湛江524002

出　　处：《广东医学院学报》2016年第1期37-41,共5页Journal of Guangdong Medical College

摘　　要：目的探讨缺血后适应(ischemic postconditioning,IPo C)对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后心功能及预后的影响。方法 71例AMI患者随机分为对照组(n=34)和IPo C组(n=37),再灌注开始3 min内,对照组不施加任何干预,而IPo C组给予30 s再灌注/30 s再闭塞的3次循环。检测术前及术后血清丙二醛(MDA)、超氧化物歧化酶(SOD)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、肌酸激酶同工酶(CK-MB)、N末端B型利钠肽原(NTpro BNP)和左心室射血分数(LVEF)水平,并记录梗死相关动脉开通后2 h内心律失常情况。结果与对照组比较,IPo C组术后TNF-α、hs-CRP、MDA、NT-pro BNP、CK-MB水平及心律失常发生率降低(P<0.05或0.01),而SOD及LVEF水平升高(P<0.05)。结论 IPo C可能通过抑制心肌炎症、氧化应激反应等机制减少心肌缺血再灌注损伤,改善AMI患者心功能及预后。Objective To investigate the effect of ischemic postconditioning（IPo C） on cardiac function and prognosis in patients with acute myocardial infarction（AMI） undergoing percutaneous coronary intervention（PCI）. Methods Seventy-one AMI patients were randomized to control（n=34） and IPo C（n=37） groups. At 3 min pre-reperfusion, control group received no intervention, while IPo C group accepted 3 episodes of 30 sec reperfusion and 30 sec reocclusion. Serum malondialdehyde（MDA）, superoxide dismutase（SOD）, high sensitive C-reactive protein（hs-CRP）, tumor necrosis factor-α（TNF-α）, creatine kinase isoenzyme MB（CK-MB）, and N-terminal pro-brain natriuretic peptide（NT-pro BNP） levels, and left ventricular ejection fraction（LVEF） were determined before and after PCI. Arrhythmic occurrence was recorded 2 h after recanalization of infarction-related artery. Results Compared with control group, TNF-α, hs-CRP, MDA, NT-pro BNP and CK-MB levels and arrhythmic occurrence were significantly decreased（P〈0.01 or 0.05）, while SOD content and LVEF were increased（P〈0.05） in IPo C group. Conclusion IPo C can reduce the ischemic-reperfusion injury by inhibiting myocardial inflammation and oxidative stress, thus improving the cardiac function and prognosis in AMI patients.

关 键 词：缺血后适应 急性心肌梗死 再灌注 经皮冠状动脉介入治疗 

分 类 号：R542.2[医药卫生—心血管疾病]