缺血后适应对急性ST段抬高型心肌梗死患者PCI介入术后缺血-再灌注损伤的预后影响  

Effects of ischemic postconditioning on prognosis of patients with acute ST-segment elevation myocardial infarction and ischemia-reperfusion injury after PCI

作　　者：沈小梅 田小晶 单红英 SHEN Xiao-mei;TIAN Xiao-jing;SHAN Hong-ying(Department of Cardiovascular Medicine,Dongtai People s Hospital,Dongtai 224200,Jiangsu;Department of Pharmacy,Dongtai People s Hospital,Dongtai 224200,Jiangsu;Department of Cardiovascular Medicine,First Medical Centre,General Hospital of the Chinese People s Liberation Army,Beijing 100089,China)

机构地区：[1]东台市人民医院心血管内科,江苏东台224200 [2]东台市人民医院药学科,江苏东台224200 [3]中国人民解放军总医院第一医学中心心血管内科,北京100089

出　　处：《川北医学院学报》2024年第2期182-185,共4页Journal of North Sichuan Medical College

基　　金：江苏省卫生计生委2017年医学科研面上项目(No.H201718)。

摘　　要：目的:观察缺血后适应(IPoC)对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后缺血-再灌注损伤(IRI)预后影响。方法:将90例STMEI患者按照不同治疗方式分为对照组(常规方法行PCI)和观察组(再灌注开始1 min内行IPoC),每组各45例。比较两组患者ST段回落情况,心肌再灌注评价,心肌坏死标志物,心功能指标,外周血氨基末端B型钠尿肽原(NT-proBNP)、超敏C反应蛋白(hs-CRP)、内皮素1(ET-1)和主要心脏不良事件。结果:观察组患者术后6 h完全回落高于术后2 h(P<0.05);术后心肌再灌注评价指标CTFC和WMSI,心肌坏死标志物c-TnI、CK和CK-MB,外周血NT-proBNP、hs-CRP和ET-1水平均低于对照组(P<0.05);主要心脏不良事件发生率低于对照组(P<0.05)。结论:IPoC能有效改善STMEI患者PCI介入后IRI,能降低心肌酶和NT-proBNP、hs-CRP和ET-1水平,改善预后,值得临床应用推广。Objective:To observe the effects of ischemic postconditioning(IPoC)on prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI)complicated with ischemia-reperfusion injury(IRI)after percutaneous coronary intervention(PCI).Methods:90 patients with STEMI were divided into 45 cases in control group(PCI by conventional method)and 45 cases in observation group(IPoC within 1 min of reperfusion).ST-segment resolution,myocardial reperfusion evaluation,myocardial necrosis markers,cardiac function indicators and levels of peripheral blood N-terminal pro-B-type natriuretic peptide(NT-proBNP),hypersensitivity C-reactive protein(hs-CRP)and endothelin-1(ET-1)were compared between the two groups of patients,and the major cardiac adverse events were recorded in the two groups.Results:The complete resolution at 6 hours after surgery in observation group was higher than that at 2 hours after surgery(P<0.05).The myocardial reperfusion evaluation indicators of CTFC and WMSI,myocardial necrosis markers of c-TnI,CK and peripheral blood CK-MB,NT-proBNP,hs-CRP and ET-1 levels in observation group after surgery were lower than those in control group(P<0.05).The incidence of major adverse cardiac events in observation group was lower compared to control group(P<0.05).Conclusion:IPoC can effectively improve the IRI of patients with STEMI after PCI,reduce the levels of myocardial enzymes,NT-proBNP,hs-CRP and ET-1,improve the prognosis,and is worthy of clinical application and promotion.

关 键 词：缺血后适应 经皮冠状动脉介入术 急性ST段抬高型心肌梗死 缺血-再灌注损伤 

分 类 号：R542.4[医药卫生—心血管疾病]