缺血后适应在急性ST段抬高型心肌梗死急诊介入治疗中的作用研究  

Role of ischemic postconditioning in primary percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction

作　　者：甘剑挺[1] 徐广马[1] 陆政德[1] 刘宇[1] 薛焱[1] 林英忠[1] GAN Jianting;XU Guangma;LU Zhengde;LIU Yu;XUE Yan;LIN Yingzhong(Department of Cardiovascular Medicine, the People＇s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021 China)

机构地区：[1]广西壮族自治区人民医院心内科,南宁市530021

出　　处：《微创医学》2018年第2期135-139,共5页Journal of Minimally Invasive Medicine

基　　金：国家自然科学基金(编号:81760051)

摘　　要：目的探讨缺血后适应(IPC)对急性ST段抬高型心肌梗死(STEMI)接受直接经皮冠状动脉介入治疗(PCI)患者预后的影响。方法选择确诊为STEMI并在心导管室行直接PCI的患者92例,采用随机数字表法将患者分为缺血后适应试验组(44例)和常规PCI组(48例),并分别对责任病变血管(IRA)行PCI术。试验组再灌注开始1 min内,给予30 s再灌注/30 s再闭塞(通过球囊反复低气压充气/放气实现)的3次循环,然后给予持续再灌注;常规PCI组按中国PCI指南常规操作。详细采集患者临床基线资料及手术资料,对所有研究对象进行为期1年的随访,以主要心血管不良事件(MACE)作为终点。采用多因素Cox比例风险回归模型对两组研究对象MACE发生率进行探讨。结果两组年龄、性别、基线LVEF及FS水平、BMI、梗死部位、单支血管病变率、中位总缺血时间、中位D-to-B时间及术前术后TIMI血流比较,差异均无统计学意义(P>0.05)。随访1年,失访8例,失访率为8.7%。随访期间共发生MACE事件21例,其中试验组发生MACE 8例(19.5%),常规PCI组发生13例(30.2%),多因素Cox回归分析显示试验组MACE事件发生率与常规PCI组相比有下降的趋势,但差异无统计学意义(P>0.05);与此同时,试验组与常规PCI组相比,心衰再入院的发生率也并未降低(P>0.05)。结论缺血后适应并未能降低STEMI接受直接PCI患者1年MACE事件发生率。Objective To investigate the effect of ischemic postconditioning（ IPC） on the prognosis ofpatients with ST-segment elevation myocardial infarction （STEMI） undergoing percutaneous coronaryintervention（ PCI）. Methods Ninety-two patients definitely diagnosed as STEMI were enrolled,and weredivided into IPC group （ n = 44 ） and routine PCI group （ n = 48 ） using random number table. All patients underwent PCI for corresponding infarction related artery. In the IPC group, 30 seconds of by 30 seconds of reocclusion （ achieved by repeated low-pressure inflation and deflation of balloon） wasconducted within 1 minute after reperfusion for three times,then continuous reperfusioroutine PCI group received the treatment according to Chinese PCI guideline. The clinical baseline data andsurgical data of patients were collected in detail. Follow-up of 1 year was performed in all sumajor cardiovascular adverse events （ MACE） as the end point. Multivariate Cox proportional hazards regression model was used to investigate the incidence of MACE in both groups. Results There were no significant differences between the two groups in the age, sex, baseline LVEF andsite, proportion of single-vessel disease median total ischemic duration, the median D-to-B time and TIMI flow before and after operation （ P 〉 0. 05 ） . During the 1 -year follow-up, 8 cases were lost and the incidence of loss to follow-up was 8. 7%. Twenty-one MACE events occurred during follow-up, including 8 cases （19. 5% ） in IPC group and 13 cases （ 30. 2% ） in PCI group. Multivariate Cox regression analysis showed that theincidence of MACE in the IPC group was lower than that in the routine PCI group, but no significant difference was observed （P 〉 0. 05 ）. There was no significant difference in the rate of rehospitalizatifailure between the IPC group and routine PCI group（P 〉0.05）. Conclusion IPC fails to reduce the 1-yearincidence of MACE in the patients with STEMI undergoing primary PCI.

关 键 词：缺血后适应 急性ST段抬高型心肌梗死 冠脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]