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急性心肌梗死再灌注治疗中后适应在梗死相关动脉不同开通时间对再灌注心肌的保护作用 被引量:6

EFFECTS OF ISCHEMIC POSTCONDITIONING ON MYOCARDIUM TO ACUTE MYOCARDIAL INFARCTION ACCORDING TO DIFFERENT TURN-ON TIME OF INFARCTION RELATED ARTERY
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摘要 目的 探讨在急性心肌梗死(acute myocardial infarction,AMI)直接经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)中缺血后适应(ischemic postconditioning,IPC)对梗死相关动脉(Infarction Related Artery,IRA)不同开通时间再灌注心肌的保护作用。方法 观察直接PCI的首次AMI患者305例,按照发病至IRA开通时间以6h为界限,分为早期组(〈6h)和晚期组(6~12h),每组依据再灌注开始3min内,是否给予后适应处理分为早期常规组(PE)和早期后适应组(IE)及晚期常规组(PL)和晚期后适应组(IL)。术后即刻及术后6个月行超声心动图检查,测定心尖四腔切面二尖瓣环部侧壁缘舒张晚期峰流速(Aa)、舒张早期峰速度(Ea),收缩期峰流速(S),并计算Ea/Aa。随访至术后6个月,观察临床转归。结果 1早期后适应组的Ea/Aa及S的变化值即心功能改善情况优于早期常规组、晚期后适应组及晚期常规组,差异有统计学意义(P〈0.05),晚期后适应组与晚期常规组比较差异无统计学意义(P〉0.05);2随访期内早期后适应组转归明显优于早期常规治疗组及晚期后适应组,差异有统计学意义(P〈0.05)。结论 缺血后适应在急性心肌梗死直接冠脉成形术中,可改善左心室心肌重构,提高左心室功能,尤其对于冠脉开通相对较早的患者,可改善其转归。 Objective To evaluate the protection of ischemic postconditioning (IPC) in acute myocardial in‐farction according to different Turn - on time of infarction related artery (IRA) .Methods A total of 305 cases with first - time AMI undergoing emergency PCI were enrolled in the study ,they were sorted into E group(〈 6h) and L group(6 ~ 12h) according to Turn - on time ,each group was randomly sorted into IE and PE group ,as IL and PL group according to whether adopted postconditioning for 3 times in the follow‐ing 3 minutes after reperfusion .Echocardiographic examination was conducted before and 6 months after the operation ,measured the peak rate of mitral in early and end diastole as Ea and Aa ,and in systole as S , calculated Ea/Aa .Following up for 6 months ,observed clinical outcome .Results There was statistical significance for variation of Ea/Aa and S between the IE group and those three groups (P〈0 .05) .There was no statistical significance between the PE and PL group (P〉0 .05) .During the Follow - up period , outcome in IE group was better than that in PE and IP group (P〈0 .05) .Conclusions In percutaneous coronary intervention ,ischemic postconditioning can improve function of left ventricular by advance myo ‐cardial remodeling ,especially to those who are in shorter turn - on time ,it can improve their outcome .
出处 《中国煤炭工业医学杂志》 2016年第12期1683-1686,共4页 Chinese Journal of Coal Industry Medicine
基金 河北省医学科学研究课题计划项目(编号:20150507)
关键词 急性心肌梗死 缺血后适应 IRA开通时间 经皮冠状动脉介入治疗 Acute myocardial infarction Ischemic postconditioning Percutaneous IRA turn - on time Coronary intervention
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