缺血预适应在经皮冠状动脉腔内成形术中的应用

The role of ischemic preconditioning in percutaneous transluminal coronary angioplasty

对２６例冠心病患者随机分为预适应组（１４例）和对照组（１２例），分别观察经皮冠状动脉腔内成形术（ＰＴＣＡ）中心绞痛及心电图变化和术后心绞痛及运动心电图。结果显示：预适应组术中心绞痛积分和ＳＴ段抬高幅度均显著低于对照组（均Ｐ＜０．０５），心绞痛及ＳＴ段抬高出现时间均显著迟于对照组（均Ｐ＜０．０５）。术后随访６个月，预适应组心绞痛及运动心电图阳性例数显著低于对照组（均Ｐ＜０．０５）。表明缺血预适应不但可以减轻ＰＴＣＡ中心肌缺血的程度，而且也能降低术后心肌缺血的复发。

The effect of ischemic preconditioning on percutaneous transluminal coronary angioplasty(PTCA) was observed in this study. 26 patients with coronary heart disease were divided into two groups. Preconditioning group (n=14) was preconditioned with 60 seconds coronary artery occlusions plus 5 min reperfusion and repeated twice before PTCA. Control group(n=12) did not receive coronary artery occlusions before PTCA. Anginal discomfort score and the height of ST segment deviation were observed during PTCA. The recurrent angina and exercise electrocardiography were observed during 6 months follow-up period.Results showed that:the anginal discomfort score(1.7±0.5) and the height of ST segment deviation(0.24±0.09 mV) in preconditioning group were lower than that in control group(2.2±0.6,0.39±0.12mV,all P<0.05).The initial time of angina(48.2±11.3 s) and ST segment elevation(38.3±9.6 s) in preconditioning group were later than that in control group(39.6±8.7s,27.9±6.3s,P<0.05).Durring the follow-up period,the incidence of recurrent angina(1 case) and positive exercise electrocardiography(2 cases) were lower than that(6 cases and 8 cases) in control group(P<0.05).The results suggest ischemic preconditioning not only protects myocardium in PTCA but also improve the effects of PTCA.