【摘要】 目的探讨缺血后适应(ischemic postconditioning,IPOC)对单支动脉闭塞性急性心肌梗死(acute myocardial infarctio,AMI)患者近期预后的影响。方法采用简单随机抽签法将150例于2014年3月至2017年9月在潮州市中心医院行经皮冠状动脉动脉介入治疗(percutaneous coronary intervention,PCI)的单支动脉闭塞性AMI患者分为观察组(n=75)和对照组(n=75),观察组于再灌注开始1 min内实施IPOC策略,对照组再灌注开始6 min内不施加干预,比较两组术中血流恢复[心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流分级、校正TIMI帧数(corrected TIMI frame count,cTFC)]及再灌注心律失常发生情况,PCI治疗后测定外周血肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)、高敏心肌肌钙蛋白(high-sensitivity cardiac troponin T,hs-cTnT)峰值,于入院时及术后3个月检测血浆N氨基酸末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、左心室射血分数(left ventricular ejection fraction,LVEF),并记录随访3个月内主要不良心血管事件(major adverse cardiovascular events,MACE)发生情况。结果观察组术中较对照组梗死相关动脉TIMI血流3级患者比例明显升高,cTFC明显减小,差异均有统计学意义(P<0.05)。观察组术中频发室性期前收缩、室性心动过速、室性停搏等再灌注心律失常发生率均较对照组明显降低,差异均有统计学意义(P<0.05)。观察组PCI治疗后CK-MB、cTnI浓度均明显低于对照组,差异有统计学意义(P<0.05)。PCI治疗后3个月,观察组较对照组NT-proBNP浓度降低,LVEF增高,差异有统计学意义(P<0.05);随访3个月内,观察组MACE发生率为18.67%,明显低于对照组的36.00%,差异有统计学意义(P<0.05)。结论 IPOC能够显著加快AMI患者急诊PCI治疗中冠状动脉血流,减少再灌注心律失常发生,保护心肌损伤,改善预后。更多还原

【Abstract】 Objectives To investigate the effect of ischemic postconditioning(IPOC)on the short-term prognosis of patients with single artery occlusion of acute myocardial infarction(AMI). Methods One hundred and fifty patients with single-artery occlusion of AMI who underwent percutaneous coronary intervention(PCI)from March 2014 to September 2017 in The Central Hospital of Chaozhou City were randomly divided into observation group(n=75)and control group(n=75). IPOC was carried out in observation group within 1 min after the beginning of reperfusion,while no intervention was performed in control group within 6 min after the beginning of reperfusion. Intraoperative blood flow recovery[thrombolysis in myocardial infarction(TIMI)blood flow classification,corrected TIMI frame count(cTFC)]and incidence of reperfusion arrhythmia were compared between the two groups. Concentrations of peripheral blood creatine kinase isoenzyme(CK-MB)and high-sensitivity cardiac troponin T(hs-cTnT)were detected before and after PCI. Plasma concentration of N-terminal pro-brain natriuretic peptide(NT-proBNP)and left ventricular ejection fraction(LVEF)were detected at admission and 3 months after operation. Occurrence of major adverse cardiovascular events(MACE)during 3 months of follow-up was recorded. Results Percentage of patients with infarct related artery(IRA)TIMI grade 3 blood flow in observation group was significantly higher than that in control group(P<0.05),while cTFC in observation group was significantly smaller than that in control group(P<0.05). Incidence of reperfusion arrhythmia,such as frequent ventricular premature beats,ventricular tachycardia and ventricular arrest in the observation group during PCI was significantly lower than that in control group(P<0.05). Concentrations of CK-MB and cTnT in observation group were significantly lower than those in control group at 24 hours after PCI(P<0.05).Concentrations of NT-proBNP in observation group was lower,while LVEF was higher than that in control group at 3 months after PCI(P<0.05). Incidence of MACE in observation group was significantly lower than that in control group(18.67% vs. 36.00%,P<0.05). Conclusions IPOC can significantly accelerate the coronary blood flow in patients with AMI during emergency PCI,decrease the occurrence of reperfusion arrhythmia,protect myocardial injury and improve the prognosis.更多还原