【摘要】 目的探讨急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉内介入治疗(PCI)术中应用缺血后适应(IPC)对术后心肌灌注水平的影响和机制以及与患者临床预后的关系。方法选择2012年1月至2014年1月在广州市第一人民医院心内科CCU住院诊断为STEMI的患者160例,入选患者均在起病12 h以内接受直接PCI治疗,按照随机数字表法将患者分为IPC组(78例)和对照组(82例)。对照组按常规直接PCI操作,IPC组在直接PCI中实施IPC操作。观察两组患者术后2 h ST段回落(STR);校正TIMI帧计数(CTFC)以及术前、术后内皮细胞功能指标一氧化氮(NO)、内皮素-1(ET-1)。PCI术后对患者随访6个月,记录随访期间发生的心脏不良事件(MACE)的情况。结果 IPC组STEMI患者术后STR比例、CTFC及血管内皮细胞功能指标NO及ET-1优于对照组[84.62%vs.67.10%,P<0.05;(27.94±4.36)帧vs.(30.17±4.52)帧,P<0.05;(52.37±3.84)μmol/L vs.(50.95±3.85)μmol/L,P<0.05;(75.47±3.47)ng/L vs.(76.60±3.72)ng/L,P<0.05],且PCI术中应用IPC并无严重并发症发生。术后随访6个月,Kaplan-Meier生存分析显示,IPC组患者随访期间累积无MACE事件发生的生存率高于对照组,差异有统计学意义(96.2%vs.86.6%,Log rank=4.581,P=0.032)。结论 STEMI患者直接PCI术中实施IPC能改善患者术后心肌灌注水平,其机制可能与血管内皮功能的改善相关。并且IPC应用能降低STEM患者PCI术后MACE的发生,改善临床预后。更多还原

【Abstract】 Objective To investigate the effects and mechanisms of ischemic postconditioning(IPC) on the myocardial perfusion levels of acute ST-segment elevation myocardial infarction(STEMI) patients underwent primary percutaneous coronary intervention(PCI). Methods 160 STEMI patients hospitalized in our Coronary Care Unit(CCU) from January 2012 to January 2014 were enrolled. All the patients received primary PCI therapies within 12 hours since chest pain onset and were randomly divided into two groups according to whether IPC was applied in the PCI: control group(n=82) and IPC group(n=78). The ST-segment resolution(STR), corrected TIMI frame count(CTFC) and the indicators of endothelial function including nitric oxide(NO), endothelin-1(ET-1) before and after PCI in both groups were measured. After PCI, patients were followed up for 6 months and major adverse cardiac events(MACE) of patients happened during the periods were recorded. Results Compared with control group, patients in IPC group had better STR ratio and CTFC after primary PCI, and NO and ET-1, the two indicators of endothelial function of patients in IPC group were superior to patients of control group [84.62% vs. 67.10%, P<0.05;(27.94±4.36)frame vs.(30.17±4.52)frame, P<0.05;(52.37±3.84)μmol/L vs.(50.95±3.85)μmol/L, P<0.05;(75.47±3.47)ng/L vs.(76.60±3.72)ng/L, P<0.05]. Moreover, there weren’t any severe complications took place in IPC group. Kaplan-Meier survival analysis showed that patients of two groups had significantly different cumulative non-events survival rates(96.2% vs. 86.6%, Log rank=4.581, P=0.032). Conclusions Applying IPC in patients with STEMI can improve myocardial perfusion levels post primary PCI. The improvement of vessel endothelial function attained from IPC may be the major mechanism. IPC application can also improve the prognosis of STEMI patients.更多还原