心肌缺血预适应在紫杉醇释放冠脉球囊导管扩张术中的应用  

Application of Myocardial Ischemia Preconditioning in Paclitaxel-Eluting Coronary Balloon Dilatation Coronary Angioplasty Catheterization

作　　者：王硕 孙爱[2] 张慧杰 尤杨[2] 魏立业[2] 李柳[2] WANG Shuo;SUN Ai;ZHANG Hui-jie;YOU Yang;WEI Li-ye;LI Liu(Dept.of Cardiology,Shijiazhuang People’s Hospital,Shijiazhuang Hebei 050011;Dept.of Cardiology,Hebei Medical University First Hospital,Shijiazhuang Hebei 050011,China)

机构地区：[1]石家庄市人民医院心内科,河北石家庄050011 [2]河北医科大学第一医院心内科,河北石家庄050011

出　　处：《昆明医科大学学报》2021年第12期89-94,共6页Journal of Kunming Medical University

基　　金：河北省卫生健康委员会青年科技课题基金资助项目(20210480);河北省卫生健康委员会科研基金资助项目(20190471)。

摘　　要：目的评价心肌缺血预适应在紫杉醇释放冠脉球囊导管术中应用价值。方法纳入行紫杉醇释放冠脉球囊导管患者210名,随机分为3组,一组为对照组,术中依据手术常规行药物球囊扩张术;二组为半分钟预适应组,在药物球囊扩张前,间隔3 min 2次应用非顺应性球囊扩张狭窄部位30 s;三组为1 min适应组,在药物球囊扩张前,间隔3 min 2次应用非顺应性球囊扩张狭窄部位60 s。所有患者行冠脉SYNTAX II评分,记录经皮腔内冠状动脉成形术(percutaneous transluminal coronary angioplasty,PTCA)术前及术后24 h肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)数值,记录术中发生心绞痛、快速型心律失常、缓慢型心律失常的情况,并随访所有患者术后180 d内发生MACE事件(包括包括心脏死亡、心肌梗死、心力衰竭、心脏原因再次入院、靶血管再次血运重建)及临床症状改善的情况。结果(1)3组患者PTCA术前CK、CK-MB、cTnI,以及术中发生心绞痛、快速型心律失常、缓慢型心律失常的情况,差异无统计学意义(P>0.05),1 min适应组患者在PTCA术后24 h的CK、CK-MB、cTnI显著低于对照组及半分钟预适应组(P<0.05);(2)1 min适应组患者在PTCA术后180 d内MACE事件发生率及临床症状改善情况显著优于对照组及半分钟预适应组(P<0.05)。结论(1)心肌缺血预适应在紫杉醇释放冠脉球囊导管术中应用可减少心肌坏死;(2)心肌缺血预适应在紫杉醇释放冠脉球囊导管术中应用可改善PTCA术预后及临床症状。Objective To evaluate the efficacy of myocardial ischemic preconditioning in paclitaxel eluting PTCA balloon catheter.Methods A total of 210 patients who underwent paclitaxel eluting PTCA balloon catheter were randomly divided into 3 groups.The control group received percutaneous paclitaxel eluting coronary balloon dilatation coronary angioplasty was performed according to the routine operation;The second group,half minute ischemic preconditioning group,received non compliant balloon dilation twice for 30 seconds interval 3 minutes.The third group,minute ischemic preconditioning group,received non compliant balloon dilation was applied twice for 60 seconds interval 3 minutes.Coronary SYNTAX II scores were recorded for all patients,percutaneous transluminal coronary angioplasty(PTCA),the values of creatine kinase(CK),creatine kinase isoenzyme(CKMB)and cardiac troponin I(cTnI)were recorded before and 24 hours after operation.All patients were followed up for MACE events(including cardiac death,myocardial infarction,heart failure,cardiac readmission,target vessel re-vascularization)and improvement of clinical symptoms within 180 days after surgery.Results(1)There was no significant difference in myocardial injury markers before PTCA,occurrence of angina pectoris,tachyarrhythmia and bradyarrhythmia during PTCA among the three groups(P>0.05),but the myocardial injury markers 24 hours after PTCA in 1 minute ischemic preconditioning group was significantly lower than that in the control group and half minute preconditioning group(P<0.05);(2)The incidence of MACE events and the improvement of clinical symptoms within 180 days after PTCA in 1 minute ischemic preconditioning group were significantly better than those in the control group and half minute preconditioning group(P<0.05).Conclusion(1)Myocardial ischemic preconditioning in paclitaxel eluting coronary balloon catheter can reduce myocardial injury;(2)Myocardial ischemic preconditioning in paclitaxel eluting coronary balloon catheter can improve the prognosis and c

关 键 词：缺血预适应 紫杉醇释放冠脉球囊导管 药物涂层球囊 冠脉SYNTAX II评分 经皮腔内冠状动脉成形术 主要不良心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]