渐进式缺血后适应对PPCI术后冠状动脉微循环功能影响的研究  

Effect of Gradual Ischemic Postconditioning on Coronary Microcirculation Function After PPCI

作　　者：莫雁飞 王沣 刘磊[2] 吴冰颖 王俊锋[2] 许浩军[2] 于宗良[2] MO Yan-fei;WANG Feng;LIU Lei;WU Bing-ying;WANG Jun-feng;XU Hao-jun;YU Zong-liang(Department of Cardiology,Pukou Hospital of Traditional Chinese Medicine/Pukou Branch of Nanjing Hospital of Traditional Chinese Medicine,Nanjing 210029,Jiangsu,China;Department of Cardiology,Kunshan Hospital Affiliated to Jiangsu University/Kunshan First People's Hospital,Kunshan 215300,Jiangsu,China)

机构地区：[1]南京市浦口区中医院/南京市中医院浦口分院心血管内科,江苏南京210029 [2]江苏大学附属昆山医院/昆山市第一人民医院心血管内科,江苏昆山215300

出　　处：《医学信息》2021年第20期1-5,共5页Journal of Medical Information

基　　金：江苏大学医学临床科技发展基金项目(编号:JLY20160044)。

摘　　要：目的观察直接经皮冠状动脉介入治疗(PPCI)术时应用渐进式缺血后适应(IPostC)对冠状动脉微循环功能的影响。方法选择2017年12月-2020年6月在江苏大学附属昆山医院/江苏省昆山市第一人民医院心内科及南京市中医院浦口分院/浦口区中医院心内科住院的急性ST段抬高型心肌梗死患者(STEMI)65例为研究对象。将患者通过随机数字表法分为IPostC组(21例)、渐进式IPostC组(23例)及常规组(21例)。观察各组TIMI血流分级、抬高的ST段回落幅度总和百分比(Sum-STR)、TIMI心肌灌注帧数计算(TMPFC),比较计算各组CK-MB峰值、评价术后心脏功能。结果IPostC组和渐进IPostC组Sum-STR、TIMI 0~1级血流发生率、TIMI 3级血流比率、TMPFC值优于常规组,差异有统计学意义(P<0.05),渐进式IPostC组优于IPostC组;三组TIMI 2级血流比率比较,差异无统计学意义(P>0.05);术后7 d三组LVEF、LVEDD比较,差异无统计学意义(P>0.05);术后3个月IPostC组和渐进IPostC组LVEF均高于常规组(P<0.05),其中渐进式IPostC组LVEF提高更为明显;IPostC组和渐进IPostC组CK-MB峰值明显较常规组低(P<0.05);随访至3个月,渐进IPostC组MACEs发生率最低,总死亡率4.61%,各组均无大出血事件发生。结论渐进式IPostC能够更有效降低患者PPCI术中冠状动脉微循环功能障碍发生、改善左室功能。Objective To observe the effect of gradual ischemic postconditioning(IPostC)on microcirculation in primary percutaneous coronary intervention(PPCI).Methods Sixty-five patients with acute ST-segment elevation myocardial infarction(STEMI)hospitalized in the Department of Cardiology,Kunshan Hospital Affiliated to Jiangsu University/Kunshan First People's Hospital and Pukou Branch of Nanjing Hospital of Traditional Chinese Medicine/Pukou Hospital of Traditional Chinese Medicine from December 2017 to November 2019 were selected as subjects.Patients were randomly divided into IPostC group(21 cases),gradual IPostC group(23 cases)and conventional group(21 cases).The TIMI blood flow classification,the total percentage of elevated ST segment depression(Sum-STR)and the number of TIMI myocardial perfusion frames(TMPFC)in each group were observed,and the CK-MB peak values in each group were compared and calculated to evaluate the postoperative cardiac function.Results The incidence of Sum-STR,TIMI 0-1 blood flow rate,TIMI3 blood flow rate and TMPFC in IPostC group and gradual IPostC group were better than those in the conventional group,the differences were statistically significant(P<0.05),and gradual IPostC group was better than IPostC group;there was no statistically significant difference in TIMI level 2 blood flow among the three groups(P>0.05);there was no significant difference in LVEF and LVEDD among the three groups on 7 d after operation(P>0.05);on 3 months after operation,LVEF in IPostC group and gradual IPostC group were higher than those in conventional group(P<0.05),and LVEF in gradual IPostC group increased more significantly;the peak value of CK-MB in IPostC group and gradual IPostC group was significantly lower than that in conventional group(P<0.05);follow-up to 3 months,the incidence of MACEs in progressive IPostC group was the lowest,and the total mortality rate was 4.61%,there was no massive hemorrhage in each group.Conclusion Gradual IPostC can more effectively reduce coronary microcirculation dysfunctio

关 键 词：渐进式缺血后适应 ST段抬高型心肌梗死 经皮冠状动脉介入 微循环功能 

分 类 号：R542.22[医药卫生—心血管疾病]