急性ST段抬高型心肌梗死患者缺血后处理对心肌梗死面积的影响  

Infraction size in patients with acute ST-elevation myocardial infraction after ischemia post-conditioning

作　　者：闫卫军[1] 李小静[1] YAN Weijun;LI Xiaojing(Emergency Department,Yan＇an People＇s Hospital,Yanan,Shaanxi,716000,China)

机构地区：[1]延安市人民医院急诊科,陕西延安716000

出　　处：《临床心血管病杂志》2018年第11期1095-1099,共5页Journal of Clinical Cardiology

摘　　要：目的:评估缺血后处理(IPost)对直接经皮冠状动脉介入治疗术(PCI)治疗的急性ST段抬高型心肌梗死(STEMI)患者梗死面积的影响。方法:将于我院接受治疗的268例急性STEMI患者根据是否接受IPost随机分为IPost组和对照组。IPost组患者完全复灌前给予1min再闭塞/1min再灌注反复4次完成IPost处理,之后行支架置入术。对照组再灌注后直接行支架置入术。结果:对照组和IPost组4个月后梗死面积分别为14.3%和13.2%(P=0.17)。影响梗死面积的独立风险因素包括症状发作-球囊扩张时间和前壁梗死。PCI术后心肌灌注分级、再灌注60min后ST回落幅度、肌钙蛋白T峰值或4个月后左心室射血分数(LVEF)值未见组间差异(均P>0.05)。在两次接受心脏磁共振(CMR)的患者中,IPost对患者心肌挽救指数和LVEF均无显著影响(P>0.05)。结论:未发现IPost对梗死面积或次要研究结局存在显著影响。Objective：To evaluate the effect of ischemia post-conditioning（IPost）on infraction size in acute ST-elevation myocardial infraction（STEMI）patients underwent percutaneous coronary intervention（PCI）.Method：A total of 268 patients with STEMI treated in our hospital were randomly divided into IPost group and control group according to whether underwent the ischemia post-conditioning or not.Post-conditioning in patients of IPost group were finished by four episodes of 1-min reocclusion and 1-min reperfusion,followed by stent implantation.Patients in control group were given stent implantation after reperfusion.Result：Infraction size in control group and IPost group after 4 months was 14.3%and 13.2%（P=0.17）respectively.The independent risk factors that impact the infraction size include symptom-balloon time and anterior myocardial infarction.Myocardial perfusion grade after PCI,ST resolution 60 minutes after reperfusion,troponin T or value of left ventricular ejection fraction（LVEF）after 4 months showed no significant difference between two groups（all P〉0.05）.For the patients underwent two CMR examinations,IPost didn＇t show significant effect on myocardial salvage index and LVEF（both P〉0.05）.Conclusion：IPost has no significant effect on infraction size and concerned secondary outcomes.

关 键 词：梗死面积 急性ST段抬高型心肌梗死 缺血后处理 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]