不同缺血后适应方法对改善急性ST段抬高型心肌梗死患者缺血再灌注损伤中的保护作用  

Protective effect of different ischemic adaptation methods on ischemia-reperfusion injury in patients with acute ST-segment elevation myocardial infarction

作　　者：王俊蒙 杨平[2] 梁亚州 李勇[2] 丁永丽 王娟[2] 邢福娅 WANG Jun-meng;YANG Ping;LIANG Ya-zhou;LI Yong;DING Yong-li;WANG Juan;XING Fu-ya(Electrocardiographic Room,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Dardiovascular Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州市第一人民医院心电图室,郑州450052 [2]郑州市第一人民医院心血管内科,郑州450052

出　　处：《医药论坛杂志》2024年第2期126-130,共5页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190991);郑州市科技惠民计划项目(172PKJHM347)。

摘　　要：目的探讨不同的缺血后适应(postischemia conditioning,PIC)方法对改善急性ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)患者缺血再灌注损伤中的保护作用。方法本研究入选患者为2021年8月至2022年10月在郑州市第一人民医院心内科住院且发病后12 h内接受急诊PCI的STEMI患者。依据不同的PIC方法分组,分成A、B、C、D、E五组,每组各30例。A组在导引导丝通过梗死相关动脉或球囊扩张后(支架植入前)行直接支架植入术,B组在导丝通过后1 min分别予以预扩张球囊10 s缺血/10 s再灌注3次,后常规支架置入术;C组在导丝通过后1 min分别予以预扩张球囊30 s缺血/10 s再灌注3次,后常规支架置入;D组在导丝通过后3 min分别予以预扩张球囊10 s缺血/10 s再灌注3次,后常规支架置入;E组在导丝通过后3 min分别予以预扩张球囊30 s缺血/10 s再灌注3次,后常规支架置入。观察五组患者的一般临床资料、疗效评价指标、安全性指标。结果五组患者在年龄、性别、危险因素、发病至就诊时间、发病至梗死相关血管开通时间等方面比较差异无统计学意义(P>0.05)。与A组比较,B、C、D、E组患者在TFC、cTFC、心电图ST段回落率等方面有明显改善,差异有统计学意义(P<0.05),但在再灌注损伤方面、术后心功能、TIMI、TMPG等方面比较差异无统计学意义(P>0.05);安全性指标方面,五组间比较无统计学差异(P>0.05)。结论缺血后适应对急性ST段抬高型心肌梗死患者的缺血再灌注损伤有保护作用,缺血后适应操作越早可能对于缺血再灌注损伤保护更佳。Objective To investigate the protective effect of different postischemia conditioning(PIC)methods on ische⁃mia-reperfusion injury in patients with acute ST-segment elevation myocardial infarction.Methods Enrolled patients were STEMI patients admitted to the Department of Cardiology of Zhengzhou the First People's Hospital between August 2021 and October 2022 who underwent emergency PCI within 12 hours of onset.According to different PIC methods,they were divided into five groups,A,B,C,D and E,with 30 cases in each group.Group A underwent direct stent im⁃plantation after the guide wire was dilated through the infarct-related artery or balloon(before stent implantation);Group B underwent pre-dilated balloon for 10s ischemia/10s reperfusion 3 times one minute after the guide wire was passed,and then conventional stent implantation was performed.Group C:1 minute after the passage of the guide wire,the balloon was pre-dilated for 30 seconds ischemia/10 seconds reperfusion for 3 times,and then conventional stent implantation;Group D:3 minutes after the passage of the guide wire,the balloon was predilated for 10s ischemia/10s reperfusion for 3 times,and then conventional stent was implanted;Group E:3 minutes after the passage of the guide wire,the balloon was pre-dilated for 30s ischemia/10s reperfusion for 3 times respectively,and then routine stent im⁃plantation was performed.The general clinical data,efficacy evaluation indexes and safety indexes of the five groups were observed.Results There was no significant difference in age,gender,risk factors,time from onset to visit a doc⁃tor,and time of opening of infarct-related vessels between the five groups(P>0.05).Compared with the group A,others had significant improvement in TFC,cTFC and ST segment regression rate of ECG,with statistical significance(P<0.05),but there was no statistical significance in reperfusion injury,postoperative cardiac function,TIMI,TMPG and other aspects(P>0.05).There was no significant difference in safety indexes among the five groups

关 键 词：缺血后适应 急性ST段抬高型心肌梗死 缺血再灌注损伤 保护作用 

分 类 号：R542.2[医药卫生—心血管疾病]