缺血后处理改善前壁急性心肌梗死患者再灌注心肌长轴的收缩功能  

Ischemic postconditioning improves longitudinal contractile function of the reperfused myocardium in patients with anterior wall acute myocardial infarction

作　　者：杨祖荣[1] 周启昌[1] 方臻飞[2] 余丽[1] 周嘉炜[1] 赵白桦[1] YANG Zurong;ZHOU Qichang;FANG Zhenfei;YU Li;ZHOU Jiawei;ZHAO Baihua(Department of Ultrasonography,Second Xiangya Hospital,Central South University,Changsha 410011,China;Department of Cardiovascular Medicine,Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院超声科,长沙410011 [2]中南大学湘雅二医院心血管内科,长沙410011

出　　处：《中南大学学报（医学版）》2019年第12期1397-1405,共9页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(30970838)~~

摘　　要：目的:探讨缺血后处理(ischemic postconditioning,IPTC)是否能改善左心室受损的局部或整体长轴的收缩功能。方法:试验分为PCI组、PCI+IPTC组及对照组。PCI组为前壁急性ST段抬高型心肌梗死患者(ST-segment elevation myocardial infarction,STEMI)患者32例,行首次急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术;PCI+IPTC组为前壁急性STEMI患者28例,行急诊PCI联合IPTC术;对照组为30例,行冠状动脉造影术。采集术前,术后0.5 h,1 d,3 d,1周,1个月和6个月二维动态超声心动图。对比研究PCI组、PCI+IPTC组与对照组各时间点局部与整体长轴应变参数。结果:PCI+IPTC组PCI术后1周内左心室梗死节段长轴应变高于PCI组(P<0.05),左心室整体长轴应变较PCI组有增高趋势,但差异无统计学意义(P>0.05);PCI+IPTC组术后远期左心室局部及整体长轴应变与PCI组比较,差异均无统计学意义(均P>0.05)。结论:IPTC可改善前壁急性STEMI患者PCI术后早期左心室再灌注心肌的长轴收缩功能。Objective:To investigate whether ischemic postconditioning (IPTC) can promote the recovery of left ventricular impaired regional or global longitudinal systolic function.Methods:The trial was divided into a percutaneous coronary intervention (PCI) group,an PCI+IPTC group and a control group.Thirty-two patients with anterior acute anterior wall ST-segment elevation myocardial infarction (STEMI) underwent the first emergency PCI in the PCI group,28 patients with anterior acute STEMI underwent the combination of PCI and IPTC in the PCI+IPTC group,while 30 patients underwent coronary angiography in the control group.Two-dimensional dynamic echocardiography was collected before operation,0.5 h,1 day,3 days,1 week,1 month and 6 months after operation,respectively.The longitudinal strain parameters at different time points were analyzed and compared in the 3 groups.Results:The regional longitudinal strain of infracted segments in the PCI+IPTC group after the operation within 1 week was higher than that in the PCI group (P<0.05).The left ventricular global longitudinal strain in the PCI+IPTC group seemed to be higher than that in PCI group after the operation within 1 week,but there was not statistically difference (P>0.05).There was no significant difference in the long-term regional and global longitudinal strains of left ventricle between the PCI+IPTC group and the PCI group (both P>0.05).Conclusion:The IPTC can improve the short-term longitudinal systolic function of the reperfused myocardium in patients with acute anterior wall STEMI after PCI.

关 键 词：速度矢量成像 应变 缺血后处理 经皮冠状动脉介入治疗 急性心肌梗死 

分 类 号：R542.22[医药卫生—心血管疾病]