中国医药
中國醫藥
중국의약
CHINA MEDICINE
2015年
6期
777-781
,共5页
急性心肌梗死%经皮冠状动脉介入治疗%缺血后适应%缺血再灌注损伤
急性心肌梗死%經皮冠狀動脈介入治療%缺血後適應%缺血再灌註損傷
급성심기경사%경피관상동맥개입치료%결혈후괄응%결혈재관주손상
Acute myocardial infarction%Percutaneous coronary intervention%Ischemic postconditioning%Ischemia reperfusion injury
目的 评价缺血后适应(IPOC)对急性心肌梗死(AMI)患者急诊经皮冠状动脉介入术(PCI)后的早期心肌保护作用.方法 选取2010年10月至2013年2月于首都医科大学附属北京安贞医院行急诊PCI治疗的首发AMI患者216例,按照随机数字表法分为IPOC组(114例)和对照组(102例).所有病例按照常规方法行PCI.对照组在支架置入后不予其他干预;IPOC组在支架置入再灌注的1 min内,在支架上方血流处用经皮腔内冠状动脉成形术球囊低压(4 kPa)扩张梗死相关动脉30 s,后球囊放气30 s,再扩张(6 kPa)30 s,重复3次.比较2组患者术后ST段回落情况,肌酸激酶、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白Ⅰ (c-TnⅠ)峰值,超声心动图指标[左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)和左心室射血分数(LVEF)],再灌注心律失常发生率,心肌灌注状况和术后心肌梗死溶栓治疗(TIMI)血流分级.结果 对照组术后2hST段完全回落45例(44.1％),术后4hST段完全回落54例(52.9％),术后6hST段完全回落61例(59.8％);IPOC组术后2h ST段完全回落55例(48.2％),术后4hST段完全回落68例(59.6％),术后6hST段完全回落73例(64.0％).与对照组比较,IPOC组术后2、4、6 hST段回落情况明显改善,差异有统计学意义(P＜0.05).与对照组比较,IPOC组术后肌酸激酶、CK-MB、c-TnⅠ峰值明显减低[(1 418 ±634)U/L比(2 324±862) U/L、(121±113) mmol/L比(188±147) mmol/L、(17±12) mmol/L比(21±10) mmol/L],差异有统计学意义(P＜0.05).与对照组比较,IPOC组患者术中及术后再灌注心律失常发生率明显降低[22.8％ (26/114)比41.2％ (42/102),5.3％(6/114)比21.6％(22/102)],差异有统计学意义(P＜0.05).对照组心肌Blush分级0～1级6例,2级33例,3级63例;IPOC组心肌Blush分级0～1级5例,2级21例,3级88例.与对照组比较,IPOC组心肌Blush分级明显改善,差异有统计学意义(P＜0.05).2组患者PCI术后24h、术后1周LVEDVI、LVESVI和LVEF,术后梗死血管TIMI血流比较,差异均无统计学意义(P＞0.05).结论 IPOC用于AMI患者PCI术后能够缩小梗死面积,降低再灌注心律失常发生率,改善微循环,产生心肌保护作用.
目的 評價缺血後適應(IPOC)對急性心肌梗死(AMI)患者急診經皮冠狀動脈介入術(PCI)後的早期心肌保護作用.方法 選取2010年10月至2013年2月于首都醫科大學附屬北京安貞醫院行急診PCI治療的首髮AMI患者216例,按照隨機數字錶法分為IPOC組(114例)和對照組(102例).所有病例按照常規方法行PCI.對照組在支架置入後不予其他榦預;IPOC組在支架置入再灌註的1 min內,在支架上方血流處用經皮腔內冠狀動脈成形術毬囊低壓(4 kPa)擴張梗死相關動脈30 s,後毬囊放氣30 s,再擴張(6 kPa)30 s,重複3次.比較2組患者術後ST段迴落情況,肌痠激酶、肌痠激酶同工酶(CK-MB)、心肌肌鈣蛋白Ⅰ (c-TnⅠ)峰值,超聲心動圖指標[左心室舒張末期容積指數(LVEDVI)、左心室收縮末期容積指數(LVESVI)和左心室射血分數(LVEF)],再灌註心律失常髮生率,心肌灌註狀況和術後心肌梗死溶栓治療(TIMI)血流分級.結果 對照組術後2hST段完全迴落45例(44.1％),術後4hST段完全迴落54例(52.9％),術後6hST段完全迴落61例(59.8％);IPOC組術後2h ST段完全迴落55例(48.2％),術後4hST段完全迴落68例(59.6％),術後6hST段完全迴落73例(64.0％).與對照組比較,IPOC組術後2、4、6 hST段迴落情況明顯改善,差異有統計學意義(P＜0.05).與對照組比較,IPOC組術後肌痠激酶、CK-MB、c-TnⅠ峰值明顯減低[(1 418 ±634)U/L比(2 324±862) U/L、(121±113) mmol/L比(188±147) mmol/L、(17±12) mmol/L比(21±10) mmol/L],差異有統計學意義(P＜0.05).與對照組比較,IPOC組患者術中及術後再灌註心律失常髮生率明顯降低[22.8％ (26/114)比41.2％ (42/102),5.3％(6/114)比21.6％(22/102)],差異有統計學意義(P＜0.05).對照組心肌Blush分級0～1級6例,2級33例,3級63例;IPOC組心肌Blush分級0～1級5例,2級21例,3級88例.與對照組比較,IPOC組心肌Blush分級明顯改善,差異有統計學意義(P＜0.05).2組患者PCI術後24h、術後1週LVEDVI、LVESVI和LVEF,術後梗死血管TIMI血流比較,差異均無統計學意義(P＞0.05).結論 IPOC用于AMI患者PCI術後能夠縮小梗死麵積,降低再灌註心律失常髮生率,改善微循環,產生心肌保護作用.
목적 평개결혈후괄응(IPOC)대급성심기경사(AMI)환자급진경피관상동맥개입술(PCI)후적조기심기보호작용.방법 선취2010년10월지2013년2월우수도의과대학부속북경안정의원행급진PCI치료적수발AMI환자216례,안조수궤수자표법분위IPOC조(114례)화대조조(102례).소유병례안조상규방법행PCI.대조조재지가치입후불여기타간예;IPOC조재지가치입재관주적1 min내,재지가상방혈류처용경피강내관상동맥성형술구낭저압(4 kPa)확장경사상관동맥30 s,후구낭방기30 s,재확장(6 kPa)30 s,중복3차.비교2조환자술후ST단회락정황,기산격매、기산격매동공매(CK-MB)、심기기개단백Ⅰ (c-TnⅠ)봉치,초성심동도지표[좌심실서장말기용적지수(LVEDVI)、좌심실수축말기용적지수(LVESVI)화좌심실사혈분수(LVEF)],재관주심률실상발생솔,심기관주상황화술후심기경사용전치료(TIMI)혈류분급.결과 대조조술후2hST단완전회락45례(44.1％),술후4hST단완전회락54례(52.9％),술후6hST단완전회락61례(59.8％);IPOC조술후2h ST단완전회락55례(48.2％),술후4hST단완전회락68례(59.6％),술후6hST단완전회락73례(64.0％).여대조조비교,IPOC조술후2、4、6 hST단회락정황명현개선,차이유통계학의의(P＜0.05).여대조조비교,IPOC조술후기산격매、CK-MB、c-TnⅠ봉치명현감저[(1 418 ±634)U/L비(2 324±862) U/L、(121±113) mmol/L비(188±147) mmol/L、(17±12) mmol/L비(21±10) mmol/L],차이유통계학의의(P＜0.05).여대조조비교,IPOC조환자술중급술후재관주심률실상발생솔명현강저[22.8％ (26/114)비41.2％ (42/102),5.3％(6/114)비21.6％(22/102)],차이유통계학의의(P＜0.05).대조조심기Blush분급0～1급6례,2급33례,3급63례;IPOC조심기Blush분급0～1급5례,2급21례,3급88례.여대조조비교,IPOC조심기Blush분급명현개선,차이유통계학의의(P＜0.05).2조환자PCI술후24h、술후1주LVEDVI、LVESVI화LVEF,술후경사혈관TIMI혈류비교,차이균무통계학의의(P＞0.05).결론 IPOC용우AMI환자PCI술후능구축소경사면적,강저재관주심률실상발생솔,개선미순배,산생심기보호작용.
Objective To evaluate the cardio-protective effect of ischemic post-conditioning (IPOC) in patients with acute myocardial infarction after emergency percutaneous coronary intervention (PCI).Methods Two hundred and sixteen patients with acute myocardial infarction who received emergency PCI were randomly divided into IPOC group (114 cases) and the control group (102 cases).Three times of balloon inflation (4 kPa,30 s) and deflation (30 s) of the stent were performed in the related artery within 1 min after stent implantation in IPOC group;no interventions were given after stent implantation in control group.The recovery of ST-segment,the peak levels of creatine kinase (CK),creatine kinase-MB (CK-MB),cardiac Troponin I (c-TNI),the echocardiographic parameters including left ventricular end-diastolic volume index (LVEDVI),left ventricular end-systolic volume index (LVESVI) and left ventricular ejection fraction (LVEF) after operation were measured and compared between the two groups.In addition,the incidences of reperfusion arrhythmias,the myocardial perfusion and thrombolysis in myocardial infarction (TIMI) flow grade were observed.Results There were 55,68,73 cases with complete recovery of ST-segment in IPOC group and 45,54,61 cases in control group at 2,4 and 6 h after operation (P ＜ 0.05).The peak levels of CK,CK-MB and c-TnⅠ in IPOC group were significantly lower than those in control group [(1 418 ±634) U/L vs (2 324 ± 862) U/L,(121 ± 113) mmol/L vs (188 ± 147) mmol/L,(17 ± 12) mmol/L vs (21 ± 10) mmol/L,respectively,P ＜ 0.05].The incidences of reperfusion arrhythmias during and after operation in IPOC group were decreased obviously compared with those in control group [22.8％(26/114) vs41.2％ (42/102),5.3％ (6/114)vs21.6％ (22/102),P＜0.05].In IPOC group,there were 5 cases of myocardial Blush grading 0-1,21 cases of Blush grading 2 and 88 cases of Blush grading 3,significantly different from those in control group [6 cases of Blush grading 0-1,33 cases of Blush grading 2 and 63 cases of Blush grading 3] (P ＜ 0.05).The LVESVI,LVEDSI,LVEF and TIMI flow grade 24 h and 1 week after operation showed no significant difference between two groups (P ＞ 0.05).Conclusion IPOC has cardioprotective effect in patients with acute myocardial infarction after PCI,which can reduce the infarct size,decrease the incidence of reperfusion arrhythmias and improve the microcirculation in myocardium.
