早期及晚期远程缺血预适应对不稳定型心绞痛经皮冠状动脉介入治疗患者的不同影响  

The different impact between late-phase of limb ischemia preconditioning and early-phase on patients with percutaneous coronary intervention

作　　者：梁家荣[1] 唐良秋[1] 陈云宪 张社兵[1] 范文茂[1] 陈宝峰[1] 陈锦峰[1] 刘相应 侯进辉 

机构地区：[1]粤北人民医院心血管内科,广东韶关512000

出　　处：《中国介入心脏病学杂志》2017年第10期568-572,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的研究早期及晚期远程缺血预适应对不稳定型心绞痛经皮冠状动脉介入治疗(PCI)患者的不同影响。方法连续入选2014年1月至2016年1月于粤北人民医院择期行PCI术不稳定型心绞痛患者160例,其中晚期远程缺血预适应组(80例)PCI术前3 d开始行右上肢缺血预适应,用血压计袖带压迫肱动脉。将血压计加压至200 mmHg(1 mmHg=0.133 k Pa),持续5 min后放气休息,间隔5 min,重复3次,共耗时30 min;早期远程缺血预适应组(80例)PCI术前2 h开始行上述方法。比较PCI术中参数及术后24 h心肌肌钙蛋白T(c TNT)、肌酸激酶同工酶(CK-MB)、高敏C反应蛋白(hs-CRP)水平及12个月不良事件发生率。结果所有患者均顺利完成PCI,术中无心肺复苏、电除颤、心源性休克等情况发生。晚期远程缺血预适应组术中胸痛[2.50%(2/80)比8.75%(7/80),P=0.018]、术中心律失常[0(0/80)比5.00%(4/80),P<0.001]、术后即刻TIMI血流≤Ⅱ级[1.25%(1/80)比6.25%(5/80),P=0.024]发生率均显著低于早期远程缺血预适应组,差异均有统计学意义。晚期远程缺血预适应组术后24 h cTnT[(11.52±2.41)pg/ml比(27.53±4.78)pg/ml,P=0.021]、CK-MB[(14.11±2.87)pg/ml比(30.23±5.17)pg/ml,P=0.032]均较早期远程缺血预适应组下降,差异均有统计学意义。两组术后24 h hs-CRP比较,差异无统计学意义(P=0.742)。K-M生存曲线显示,晚期远程缺血预适应组较早期远程缺血预适应组终点事件发生率明显下降(3.75%比13.75%),经Breslow检验P=0.024,提示两组生存率差异有统计学意义。结论晚期远程缺血预适应比早期远程缺血预适应对不稳定型心绞痛PCI术患者有更强大的心肌保护作用,并改善患者术后12个月预后。Objective To investigate the difference of late-phase of limb ischemia preconditioning （L-LIP） verse early-phase （E-LIP） on patients with percutaneous coronary intervention （PCI）. Methods A total of 160 patients with unstable angina pectoris who were planned to undergo PCI were divided equally into two groups at random.The late-phase of limb ischemia preconditioning group （80 patients） were provided with L-LIP （three 5-minute inflations up to 200mmHg by applying the sphygmomanometer cuff around the right upper arm, followed by 5-min intervals of reperfusion, twice a day） 3 days before PCI. The Early- phase of limb ischemia preconditioning group （80 patients） were provided with E-LIP （method as above） 2 hours before PCI. Comparison of procedural parameters during PCI and the levels of cTnT, CK-MB, hs-CRP were made 24 hours after PCI. Estimation of the rate of adverse events at 1 year between the two groups was evaluated by Kaplan-Meier analysis. Results Compared to the E-LIP group, the rates of angina, arrhythrnia and TIMI flow 〈~ 2 during PCI were significantly lower in the L-LIP group （all P 〈 0.05）. At 24 hours after PCI,the levels of cTnT and CK-MB were declined more significantly in the L-LIP group[（11.52 ±2.41） pg/ml vs. （27.53±4.78）pg/ml, P = 0.021： （14.11±2.87）Iu/L vs. （30.23±5.17）Iu/L,P = 0.032]. There was no difference in the level of hs-CRP between the 2 groups F （1.28±0.71） mg/dl vs. （1.33___0.69） mg/dl, P = 0.742]. The Kaplan-Meier survival curve showed that the incidence rate of adverse events in the L-LIP group at 1 year was lower than the E-LIP group （3.75% vs. 13.75%, P = 0.024）. Conclusions L-LIP is more effective to in protecting myocardial cell in patients with unstable angina pectoris undergoing elective PCI and may reduce the rate of future adverse event.

关 键 词：晚期远程缺血预适应 早期远程缺血预适应 经皮冠状动脉介入治疗 肌钙蛋白T 预后 

分 类 号：R541.4[医药卫生—心血管疾病]