CAJ | 학술논문

目的：探讨缺血后适应（ischemic postconditioning，IPC）对急性心肌梗死（AMI）直接经皮冠状动脉介入治疗（PCI）术中再灌注心肌损伤的影响。方法选择直接PCI的首次AMI患者110例，随机分为常规PCI组（n=52）和IPC组（n=58），所有患者均经右侧股动脉行CAG，并对梗死相关动脉（IRA）行PCI术。IPC组再灌注开始3 min内，给予30 s再灌注/30 s再闭塞的3次循环，然后给予持续再灌注。常规PCI组开通IRA后，再灌注开始3 min内不施加任何干预。统计PCI术中及术后2 h缓慢及快速心律失常发生的状况；每天同一时间记录常规18导联心电图至术后1周，计算校正的QT间期离散度（corrected QT dispersion，QTcd）；监测术后1周内CK-MB的变化；观察住院期间主要不良心脏事件（major adverse cardiac events，MACE）发生率。结果 IPC组术中及术后2 h内缓慢及快速性心律失常发生率分别为10.7%及23.2%，常规PCI组分别为30.0%及54.0%，IPC组再灌注心律失常发生率（33.9%）明显低于常规PCI组（84.0%），差异有统计学意义（P＜0.05）。两组患者住院期间MACE事件发生率比较，差异无统计学意义（P＞0.05）。常规PCI组和IPC组术前QTcd分别为（62.18±4.25）ms、（63.66±3.19）ms，术后1周时QTcd较术前均降低，分别为（56.89±4.67）ms、（47.31±4.43）ms，IPC组下降更显著，两组患者术后QTcd比较，差异有统计学意义（P＜0.05）。IPC组患者CK-MB峰值为（121±52）U/L，常规PCI组CK-MB峰值为（166±47）U/L，两组患者CK-MB峰值差异有统计学意义（P＜0.05）。结论缺血后适应能降低急性心肌梗死患者PCI术后再灌注心律失常的发生率，降低QTcd，减低心肌损伤。
목적：탐토결혈후괄응（ischemic postconditioning，IPC）대급성심기경사（AMI）직접경피관상동맥개입치료（PCI）술중재관주심기손상적영향。방법선택직접PCI적수차AMI환자110례，수궤분위상규PCI조（n=52）화IPC조（n=58），소유환자균경우측고동맥행CAG，병대경사상관동맥（IRA）행PCI술。IPC조재관주개시3 min내，급여30 s재관주/30 s재폐새적3차순배，연후급여지속재관주。상규PCI조개통IRA후，재관주개시3 min내불시가임하간예。통계PCI술중급술후2 h완만급쾌속심률실상발생적상황；매천동일시간기록상규18도련심전도지술후1주，계산교정적QT간기리산도（corrected QT dispersion，QTcd）；감측술후1주내CK-MB적변화；관찰주원기간주요불양심장사건（major adverse cardiac events，MACE）발생솔。결과 IPC조술중급술후2 h내완만급쾌속성심률실상발생솔분별위10.7%급23.2%，상규PCI조분별위30.0%급54.0%，IPC조재관주심률실상발생솔（33.9%）명현저우상규PCI조（84.0%），차이유통계학의의（P＜0.05）。량조환자주원기간MACE사건발생솔비교，차이무통계학의의（P＞0.05）。상규PCI조화IPC조술전QTcd분별위（62.18±4.25）ms、（63.66±3.19）ms，술후1주시QTcd교술전균강저，분별위（56.89±4.67）ms、（47.31±4.43）ms，IPC조하강경현저，량조환자술후QTcd비교，차이유통계학의의（P＜0.05）。IPC조환자CK-MB봉치위（121±52）U/L，상규PCI조CK-MB봉치위（166±47）U/L，량조환자CK-MB봉치차이유통계학의의（P＜0.05）。결론결혈후괄응능강저급성심기경사환자PCI술후재관주심률실상적발생솔，강저QTcd，감저심기손상。
Objective To investigate the influences of ischemic postconditioning (IPC) on reperfusion arrhythmia and myocardial damage in patients with acute myocardial infarction (AMI) during direct percutaneous coronary intervention (PCI). Methods The patients with first AMI treated with direct PCI (n=110) were randomly divided into routine PCI group (n=52) and IPC group (n=58). All patients were given CAG via right femoral artery, and PCI to infarction-related artery (IRA). The arrhythmia were recorded during PCI and after PCI for 2 h. The conventional 18-lead ECG was recorded at the same time every day until 1 w after PCI. The corrected QT dispersion (QTcd) was calculated, changes of CK-MB were monitored 1 w after PCI and incidence of MACE was observed during hospitalization. Results The incidence rates of bradyarrhythmia and tachyarrhythmia were 10.7%and 23.2%in IPC group during PCI and 2 h after PCI, and 30.0%and 54.0%in routine PCI group. The incidence of reperfusion arrhythmia was 33.9%in IPC group and 84.0%in routine PCI group (P<0.05). The comparison in the incidence of MACE showed no statistical significance between 2 groups (P>0.05). QTcd was (62.18±4.25) ms in routine PCI group and (63.66±3.19) ms in IPC group before PCI, and decreased 1 w after PCI [(56.89±4.67) ms in routine PCI group and (47.31±4.43) ms in IPC group], and the decrease was more significant in IPC group (P<0.05). The peak value of CK-MB was (121±52) U/L in IPC group and (166±47) U/L in routine PCI group (P<0.05). Conclusion IPC can reduce the incidence rate of reperfusion arrhythmia, decrease QTcd and relieve myocardial damage in AMI patients after PCI.