摘要
目的研究心肌缺血后适应(ischemic postconditioning,IPost)在急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗中及治疗后1周内的临床及预后影响。方法收集孝感市中心医院2017年1月至2018年12月行急诊PCI治疗的急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者的临床资料,根据PCI治疗中是否使用球囊行缺血/再灌注操作分为IPost组(n=137)及对照组(n=108),比较两组患者治疗中及治疗后1周内各项指标的差异。结果两组患者治疗前心肌肌钙蛋白I(cardiac troponin I,cTnI)浓度、血清肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)浓度、脑钠肽前体(pro-brain natriuretic peptide,pro-BNP)浓度、治疗后2 h心电图ST段回落>50%比率、治疗后1周内心律失常及血压下降发生率比较,差异无统计学意义(P>0.05)。与对照组相比,IPost组治疗后24 h的cTnI浓度、CK-MB浓度、Pro-BNP浓度,治疗中再灌注心律失常,治疗后1周内相关症状及并发症(胸闷心悸、心肌梗死后心力衰竭)发生率均明显降低,治疗后24 h心电图ST段回落率明显增加,梗死心肌室壁活动及心功能指标(左心室射血分数)明显改善,差异均有统计学意义(P<0.05)。结论与直接PCI治疗患者比较,IPost患者能明显减少心肌梗死后PCI治疗中及治疗后相关并发症发生率,有效减少治疗中心肌再灌注损伤,改善患者心功能及预后。
Objectives To investigate the clinical and prognostic impact of myocardial ischemic postconditioning(IPost)in patients during and within 1 week after emergency percutaneous coronary intervention(PCI).Methods Clinical datas of patients with acute ST-segment elevation myocardial infarction(STEMI)underwent emergency PCI in Xiaogan Central Hospital from January 2017 to December 2018 were collected.According to whether the balloon was used for ischemia/reperfusion operation,the patients were divided into IPost group(n=137)and control group(n=108).Differences of each index between the two groups during and within 1 week after PCI were compared.Results There were no significant differences in preoperative concentration of cardiac troponin I(cTnI),serum concentration of creatine kinase isoenzyme(CK-MB),concentration of pro-brain natriuretic peptide(pro-BNP),the ratio of ST-segment depression>50%of 2 hours after PCI,the occurrence rate of arrhythmia and blood pressure drop within 1 week in the two groups(P>0.05).Compared with control group,concentrations of cTnI,CK-MB,Pro-BNP,incidence of reperfusion arrhythmia during PCI,related symptoms and complications(chest tightness and palpitation,heart failure after myocardial infarction)within 1 week after PCI significantly decreased;ST-segment fall rate of the electrocardiogram 24 h after PCI significantly increased,ventricular wall activity in infarcted myocardium and cardiac function index(left ventricular ejection fraction)obviously improved 24 h after PCI in IPost group(P<0.05).Conclusions Compared with primary PCI,myocardial IPostcan significantly reduce the rate of intraoperative and post-operative complications,effectively reduce intraoperative myocardial reperfusion injury and improve cardiac function and prognosis in patients with myocar⁃dial infarction underwent PCI.
作者
邓静
邹永光
DENG Jing;ZOU Yong-guang(Department of Cardiology,Xiaogan Hospital of Wuhan University of Science and Technology,Xiaogan,Hubei 432000,China)
出处
《岭南心血管病杂志》
CAS
2020年第6期654-659,共6页
South China Journal of Cardiovascular Diseases
关键词
心肌梗死
缺血后适应
血管成形术
经腔
经皮冠状动脉
myocardial infarction
ischemic postconditioning
percutaneous coronary intervention
