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《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:

2009年第2期

页码:

236

栏目:

临床研究

出版日期:

2009-03-30

文章信息/Info

Title:

Cardioprotection of ischemic postcondition for patients with acute myocardial infarction during percutaneous coronary intervention

作者:

闫华; 李莉; 刘晓坤; 赵碧琼; 田美荣; 姜玉茹; 尚小明

唐山市工人医院心内科，河北 唐山 063000

Author(s):

YAN Hua;  LI Li;  LIU Xiao-kun;  ZHAO Bi-qiong;  TIAN Mei-rong;  JIANG Yu-ru;  SHANG Xiao-ming

Department of Cardiology, Tangshan Worker’s Hospital, Tangshan 063000, Hebei, China

关键词:

缺血后适应; 心肌梗死; 冠状动脉血管成形术; 经腔; 经皮

Keywords:

postconditioning;  myocardial infarction;  coronary angioplasty;  transluminal;  percutaneous

分类号:

R541.4

DOI:

-

文献标识码:

A

摘要:

目的 探讨心肌缺血后适应对急性心肌梗死经皮冠状动脉介入治疗术（PCI）中心肌的保护作用。方法 选择首次发生急性心肌梗死的患者105例，随机分为观察组（缺血后适应组）及对照组，均接受急诊PCI。对照组行常规PCI；观察组PCI术中设置缺血后适应方式。测定两组术前及术后肌酸激酶（CK）及肌酸激酶同工酶（CK-MB）水平；测量术后左心室舒张期末容积指数(LVEDVI)、左心室收缩期末容积指数(LVESVI)、左心室射血分数(LVEF)；观察术后严重心律失常、梗死后心绞痛、住院期间病死率发生情况。结果 与对照组比较，观察组术后CK及CK-MB峰值水平明显减低；术后3个月左心室容积减小， LVEDVI ［（64±6）ml/m2 vs （67±6）ml/m2，P＜0.05］，LVESVI［（30±4）ml/m2 vs （34±4）ml/m2，P＜0.05］，LVEF升高（0.53±0.02 vs 0.50±0.03，P＜0.05）；严重心律失常、梗死后心绞痛明显减低，差异有统计学意义（P＜0.05）；住院期间病死率的差异未达到显著水平。结论 心肌缺血后适应对急性心肌梗死PCI术中心肌有保护作用。

Abstract:

AIM To evaluate the cardioprotection of ischemic postcondition for patients with acute myocardial infarction during percutaneous coronary intervention. METHODS A total of 105 patients with AMI were enrolled the study, 54 patients were in ischemic postconditioning (PC) group and 51 patients in non-ischemic postconditioning (NPC) group. The level of plasma CK and CK-MB was detected and the indices of left ventricular end diastolic volume index, left ventricular end systolic volume index and left ventricular ejection fraction were measured by ultrasonic cardiogram after the onset of AMI. Malignant arrhythmia, angina occurred after AMI and death rate in hospital were compared between the two groups. RESULTS The peak level of plasma CK and CK-MB were higer in NPC group compared with those in PC group (P<0.05). The parameters of cardiac performance decreased significantly in PC group compared with those in NPC group. Significant difference was found in left ventricular end diastolic volume index ［（64±6）ml/m2 vs （67±6 ）ml/m2, P<0.05］, left ventricular end systolic volume index ［(30±4)ml/m2 vs （34±4）ml/m2, P<0.05］ and left ventricular ejection fraction (0.53±0.02 vs 0.50±0.03, P<0.05) in PC group 3 months after PCI. The incidence of malignant arrhythmia and angina after AMI were lower in PC group compared with that in NPC group (P<0.05) while the difference in the death rate in hospital was not significant between the two groups. CONCLUSION Ischemic postcondition has some cardioprotection for patients with acute myocardial infarction during percutaneous coronary intervention.

参考文献/References

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［4］ 连亮华，陈德伟. “缺血后适应”减少心肌缺血再灌注损伤的研究进展［J］. 中国误诊学杂志， 2007， 7（7）：1441-1443.

［5］ 刘胜辉，范谦，杨新春. 心肌缺血后处理的研究进展［J］. 心血管病学进展， 2007， 28（2）：232-234.

［6］ Zhao ZQ, Vinten-Johansen J. Postconditioning: reduction of reperfusion-induced injury［J］. Cardiovasc Res, 2006, 70（2）:200-211.

［7］ Galagudza M, Kurapeev D, Minasiana S, et al. Ischemic postconditioning: brief ischemia during rerfusion converts persistent ventricular fibrillation into regular rhythm［J］. Eur J Cardiothoracic Surg, 2004, 25（6）:1006-1010.

备注/Memo

备注/Memo:

收稿日期：2007-12-24.作者简介：闫华， 副主任医师，硕士 Email：engineerx@tom.com

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更新日期/Last Update: 2009-04-16