CAJ | 학술논문

目的：探讨急性心肌梗死（AMI）患者施行缺血后适应能否有效地降低缺血再灌注损伤，从而对心脏产生保护作用。方法选取AMI患者42例，随机分为对照组22例和缺血后适应组20例。监测2组患者PCI术前、术后2h、1、2、3d内肌酸激酶同工酶（CK-MB）值，并测定CK-MB峰值及各时间点下CK-MB平均值曲线下面积；监测PCI术前及术后2h血清C反应蛋白（CRP）、丙二醛和超氧化物歧化酶（SOD）水平；比较2组患者PCI术前及术后24h内心电图ST段回落情况。结果缺血后适应组CK-MB峰值明显低于对照组[（570．61±41．27）U/Lvs（661．80±58．55）U/L，P＜0．01]；CK-MB平均值曲线下面积明显低于对照组[（5821．19±2912．07）％vs（9843．12±3578．02）％，P＜0．01]；缺血后适应组术后2hCRP下降幅度明显低于对照组（P＜0．05）；缺血后适应组术后丙二醛下降较对照组明显（P＜0．05）；缺血后适应组术后SOD升高较对照组明显（P＜0.01）；缺血后适应组ST段回落情况较对照组高（60．0％vs45．5％，P＜0．05），对照组中有2例患者因发生恶性心律失常死亡。结论AMI患者施行缺血后适应处理能够降低CK-MB的释放，降低氧自由基含量，减轻炎性反应，使冠状动脉恢复血流情况占有明显优势，能够明显降低再灌注损伤，发挥心脏保护作用。
목적：탐토급성심기경사（AMI）환자시행결혈후괄응능부유효지강저결혈재관주손상，종이대심장산생보호작용。방법선취AMI환자42례，수궤분위대조조22례화결혈후괄응조20례。감측2조환자PCI술전、술후2h、1、2、3d내기산격매동공매（CK-MB）치，병측정CK-MB봉치급각시간점하CK-MB평균치곡선하면적；감측PCI술전급술후2h혈청C반응단백（CRP）、병이철화초양화물기화매（SOD）수평；비교2조환자PCI술전급술후24h내심전도ST단회락정황。결과결혈후괄응조CK-MB봉치명현저우대조조[（570．61±41．27）U/Lvs（661．80±58．55）U/L，P＜0．01]；CK-MB평균치곡선하면적명현저우대조조[（5821．19±2912．07）％vs（9843．12±3578．02）％，P＜0．01]；결혈후괄응조술후2hCRP하강폭도명현저우대조조（P＜0．05）；결혈후괄응조술후병이철하강교대조조명현（P＜0．05）；결혈후괄응조술후SOD승고교대조조명현（P＜0.01）；결혈후괄응조ST단회락정황교대조조고（60．0％vs45．5％，P＜0．05），대조조중유2례환자인발생악성심률실상사망。결론AMI환자시행결혈후괄응처리능구강저CK-MB적석방，강저양자유기함량，감경염성반응，사관상동맥회복혈류정황점유명현우세，능구명현강저재관주손상，발휘심장보호작용。
Objective To study whether ischemic postconditioning can effectively reduce ischemia/reperfusion (I/R)injury in acute myocardial infarction (AMI)patients .Methods Forty-two AMI patients admitted to our hospital were randomly divided into control group (n=22) and ischemic postconditioning group (n=20) .CK-MB value and average area under CK-MB curve were meas-ured before and 2 h ,1 ,2 ,3 days after PCI .Serum levels of CRP ,MDA and SOD were measured before and 2 h after PCI .ST segment falls on ECG were compared before and 24 h after PCI .Ma-lignant arrhythmia in the patients was recorded during their hospital stay .Results The peak CK-MB value ,average area under CK-MB curve ,serum levels of CRP and MDA were significantly lower while the serum SOD level was significantly higher in ischemic postconditioning group than in control group after PCI (P<0 .05 ,P<0 .01) .The ST segment fall was faster in ischemic post-conditioning group than in control group .Two patients in control group died of malignant ar-rhythmia .Conclusion Ischemic postconditioning can reduce the CK-MB release ,oxygen free radi-cal level ,inflammatory reaction ,I/R injury and restore coronary blood flow in AMI patients ,thus playing a role in protecting the heart .