晚期时相远程肢体缺血预适应对急性ST段抬高型心肌梗死择期经皮冠状动脉介入治疗患者肾功能的影响  

Renoprotection by Late-phase remote limb ischaemic preconditioning in patients with STEMI undergoing selective percutaneous coronary intervention

作　　者：梁家荣[1] 陈泽昊 唐良秋[1] 陈云宪 张社兵[1] 范文茂[1] 陈宝峰[1] 陈锦锋[1] 刘相应 LIANG Jia-rong;CHEN Ze-hao;TANG Liang-qiu;CHEN Yun-xian;ZHANG She-bing;FAN Wen-mao;CHEN Bao-feng;CHEN Jin-feng;LIU Xiang-ying(Cardiovascular Department of Yuebei People's Hospital,Shaoguan 512000,China)

机构地区：[1]粤北人民医院心血管内科,广东省韶关市512000

出　　处：《中国心血管病研究》2019年第10期908-911,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨晚期时相远程肢体缺血预适应(late-phase of limb ischemia preconditioning,L-LIP)对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)择期经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)患者肾功能的影响.方法连续选择2017年3月至2018年3月于粤北人民医院因错过再灌注时间窗而择期行PCI的STEMI患者140例,其中随机选择70例为试验组行晚期远程缺血预适应(PCI术前3天开始使用缺血预适应训练仪行双上肢缺血预适应,袖带加压高于基础血压50 mm Hg压迫肱动脉,持续5 min后放气休息间隔5 min,重复5次,早晚各执行一组),余70例为对照组术前不行远程缺血训练.比较两组PCI中参数、术后72 h急性肾功能损害(acute kidney injury,AKI)的发生率、术前后肾小球滤过率(estimated glomerular filtration rate,eGFR)及1年不良事件发生率.结果术后72 h,试验组AKI发生率明显低于对照组(10.0%比21.4%),差异有统计学意义(P<0.05).试验组术前后△eGFR(术后值减去术前值)为(-5.08±4.45)/ml,对照组为(16.07±7.82)/ml,试验组△eGFR<对照组△eGFR,差异有统计学意义(P<0.05).Kaplan-Meier生存曲线显示,随访1年,试验组终点事件发生率比对照组明显降低(P=0.041).结论晚期时相远程肢体缺血预适应对STEMI择期PCI患者肾功能有保护作用,并改善患者术后1年预后.Objective To investigate the effect of renal function in patients with STEMI undergoing selective percutaneous coronary intervention (PCI) by late-phase of limb ischemia preconditioning (L-LIP). Methods In the study, 140 patients(during March 2017 to March 2018) with STEMI undergoing selective PCI were divided equally into two groups at random. The late-phase of limb ischemia preconditioning (L-LIP) group (70 patients) accepted L丒LIP( 5-minute inflations of 50 mm Hg higher than basal blood pressure around the right upper arm, followed by 5-min intervals of reperfusion, twice a day) 3 days before PCI. The control group accepted PCI directly. Compared the parameters during PCI and estimated glomerular filtration rate (eGFR) before-after PCI, calculated the incidence of acute kidney injury (AKI) in 72 hours after PCI. Estimated the rate of adverse events at 1 year between the two groups. Results Compared to the control group, the incidence of AKI was lower in L-LIP group with statistically significant difference in 72 hours after PCI( 10.0% vs. 21.4%, P< 0.05). AeGFR(postoperation minus preoperative) in L-LIP group was less than control group[(-5.08±4.45 )/ml vs.(16.07±7.82)/ml] with statistically significant difference(P<0.05). The Kaplan-Meier survive curve showed that the incidence rate of adverse events in L?LIP group at 1 year was lower (P=0.041). Conclusion L-LIP is more effective to protect renal function in patients with STEMI undergoing selective percutaneous coronary intervention and reduces the rate of adverse event at 1 year.

关 键 词：晚期远程肢体缺血预适应 急性ST段抬高型心肌梗死 肾功能 预后 

分 类 号：R542.22[医药卫生—心血管疾病]