摘要
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CKMB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。
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.
出处
《中国循证心血管医学杂志》
2014年第2期153-155,159,共4页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
河北联合大学科学研究基金项目(z201234)
关键词
急性心肌梗死
再灌注心律失常
缺血后适应
经皮冠状动脉介入治疗
Acute myocardial infarction
Reperfusion arrhythmia
Ischemic postconditioning
Percutaneous coronary intervention
