经皮腔内冠状动脉成形术中缺血预适应现象及其对血浆内皮素水平的影响

Ischemic preconditioning in percutaneous transluminal coronary angioplasty and its influences to plasma endothelin

为研究经皮腔内冠脉成形术（PTCA）中的缺血预适应（IP）现象及其对血浆内皮素（ET）水平的影响，对33例成功的进行了PTCA的患者进行分组研究。其中10例采用缺血预适应方法，即球囊首次扩张90秒至2分钟，继以3～5分钟再灌注（A组），其余23例为非缺血预适应组（B组）。观察所有患者术中心绞痛症状及体表心电图ST段变化，并分别于术前、术后即刻、15分钟、1、3和24小时从股动脉取血，放免法测定ET水平。结果示：A组第二次扩张时心绞痛症状及ST段偏移程度均较第一次扩张时显著减轻（P＜0．05）；B组两次扩张时心绞痛症状及ST段偏移程度均无明显改变。A组术后血浆ET呈升高趋势，但与术前比较无统计学意义（P＞0．05）；B组血浆ET水平术后即刻升高，3小时达高峰，峰值较术前增高113．9％（P＜0．01），术后24小时恢复术前水平。提示IP不仅使心肌缺血程度减轻，同时可减轻PTCA对血浆ET水平的影响。

For the purpos of researching ischemic preconditioning (IP) in percutaneous transluminal coronary angioplasty (PTCA) and its influences to placma endothelin (ET) changes after PTCA,PTCA was successfully performed in 33 patients, 10 of them were pretreated with IP,that is,the first duration of balloon inflation was 90 seconds to 2 minutes followed by a reperfusion of 3 to 5 minutes. The clinical and electrocardiographic responses to coronary occlusion induced by balloon inflation were examined. Blood samples were drawn succesively from femoral artery just before PTCA and at 0 minute, 15 minutes, 1 hour, 3hours, 24 hours after the final balloon inflation to measure the plasma ET level by radio immunoassay. The results showed that,in the IP group,the second balloon in flation,compared with the initial one,was characterized by less subjective anginal discomfort (P<0. 05),less ST segment shift (P<0. 05). In addition,in the IP group,there were no significant differences between the plasma ET levels before and after PTCA. In non- ischemic- preconditioning group, the plasma ET level was significantly raised after PTCA (P<0. 05)and recovered at 24 hours,the ET peak was at 3 hours (P<0. 01). The conclusion was that a 90sec-2min coronary occlusion followed by 3-5min reperfusion might produce IP phenomenon which not only improved clinical and electrocardiographic evidences but also affected the plasma ET level.