缺血后适应联合前列地尔在直接经皮冠状动脉介入治疗ST段抬高型急性心肌梗死中的应用

Value of Postischemic Conditioning with Proprostadil in Treatment of PCI in Pa⁃tients with Acute Myocardial Infarction

目的:探讨缺血后适应和前列地尔在急性心肌梗死(AMI)患者(PCI)治疗中的应用价值。方法:选取2019年7月至2022年12月广东省潮州市人民医院收治的100例ST段抬高型AMI(STEMI)为研究对象,随机分为对照组(n=48)和研究组(n=52),对照组给予抗凝、抗血小板及冠心病二级预防治疗及直接PCI治疗,研究组在对照组的基础上联合前列地尔及缺血后适应处理。比较两组患者术中慢血流/无复流的发生情况,术后的炎症指标、肾功能、心功能、心肌酶峰值及心电图ST段回落情况、心血管不良事件等。结果:研究组术后单核细胞与HDL-C比值(MHR)、中性粒细胞与淋巴细胞比值(NLR)明显优于对照组(P均<0.05),CK-MB、cTnI峰值均明显低于对照组(P<0.05)。研究组术后BUN、Cr、eGFR明显优于对照组(P均<0.05)。随访6个月时两组患者LVEF较术后均明显增加,且研究组明显优于对照组(P<0.05)。研究组术中慢血流/无复流比例、术后2小时ST段回落≥50%比例明显优于对照组(P<0.05)。随访6个月时,研究组发生心力衰竭、心绞痛的比例明显少于对照组(P<0.05)。结论:AMI患者PCI手术治疗中联合缺血后适应及前列地尔可有效减轻术后机体炎症反应,恢复心肌再灌注,改善患者术后心肾功能及预后。

Objective:To explore the value of ischemic conditioning and application in the treatment of direct PCI inpatients with AMI.Methods:100 patients with acute ST-segment elevation myocardial infarction(STEMI)admitted to the hospital from Jul 2019 to Dec 2022 were randomly divided into control group(n=48)and study group(n=52),re-ceived direct PCI treatment and combined ischemic postconditioning therapy and the alprostadil treatment.The incidence of slow blood flow/no reflow during surgery,postoperative inflammatory markers,renal function,cardiac function,myocar-dial enzyme peaks,ST-segment regression on electrocardiograms and adverse cardiovascular events were compared be-tween the tow groups.Results:Postoperative MHR,NLR BUN,Cr,and eGFR in the study group were significantly better than those in the control group(all P<0.05).At the 6-month follow-up,the LVEF of both groups had significantly in-creased compared to the postoperative measurements.The LVEF in the study group was better than that in the control group(P<0.05).The incidence of slow blood flow/no reflow during surgery in the study group was lower than that in the control group(P<0.05).The proportion of ST segment regression≥50%in the study group 2 hours after surgery was sig-nificantly better than that in the control group(P<0.05).At the 6-month follow-up,there was significant difference in the incidence of heart failure and angina pectoris between the two group(P<0.05).Conclusion:Undergoing PCI combining ischemic postconditioning with alprostadil effectively reduces postoperative inflammatory reaction,restores myocardial re-perfusion,enhances cardiac and renal function,and ultimately improving prognosis for patients with STEMI.