缺血预适应与后适应叠加对老年急性心肌梗死急症介入治疗后的影响

Effect of preconditioning and postconditioning on emergency percutaneous coronary intervention in elderly patients with acute myocardial infarction

目的研究梗死前心绞痛(缺血预适应)与缺血后适应叠加对老年急性心肌梗死患者介入治疗后冠状动脉血流速度及预后的影响。方法选取12h内接受急症冠状动脉介入治疗的心肌梗死患者106例,35例有梗死前心绞痛症状并接受缺血后适应者为预适应与后适应叠加组(IPC+Postcon),37例单纯接受缺血后适应干预者为后适应组(Postcon),其余34例为单纯再灌注组(IR),测定校正TIMI帧数(CTFC)、血肌酸磷酸激酶(CK)、肌酸磷酸激酶同工酶(CK-MB)、丙二醛,术后8w测定室壁运动记分。结果IPC+Postcon组与Postcon组CTFC明显快于IR组(27.12±5.84,26.98±5.76vs.31.53±7.41,P<0.05),CK峰值与CK-MB峰值明显低于IR组(1243.35±801.31U/L,1238.67±817.26U/Lvs.1697.76±965.63U/L,P<0.05;120.97±78.28U/L,117.94±75.81U/Lvs.174.45±92.67U/L,P<0.05),IPC+Postcon组与Postcon组间无统计学差异;3组患者入院时MDA均高于对照组,术后各时点IPC+Postcon组与Postcon组均低于IR组。术后8wIPC+Postcon组与Postcon组室壁运动恢复优于IR组(1.16±0.12,1.17±0.11vs.1.31±0.15,P<0.05)。结论缺血后适应与预适应一样可以改善介入治疗后冠状动脉血流速度,减少自由基的生成,改善心功能。预适应与后适应叠加对上述功能的改善并无增强作用。

Objective To explore the effect of preinfaretion angina （ ischemic preconditioning, IPC） and postconditioning （ Postcon） on coronary blood flow velocity and its prognosis in elderly acute myocardial infarction （AMI） after intervention treatment. Methods 106 elderly AMI patients underwent revascularization within 12 h of onset by primary percutaneous coronary intervention （PCI） were divided into IPC ＋ Postcon group with 35 patients, Postcon group with 37 patients and IR group without IPC nor Postcon with 34 patients. Corrected TIMI frame count （ CTFC ） , creatine phosphokinase （CK） , CK-MB, malondialdehyde （ MDA ） and wall motion score index （WMSI） 8 weeks after operation were assessed. Resnits CTFC was faster （27.12±5.84, 26.98±5.76 vs. 31.53±7.41, P〈0.05）, CK and CK- MB peak value were lower [ （ 1 243.35 ± 801.31,1 238. 67 ± 817. 26 vs. 1 697.76 ± 965.63 ） U/L, P 〈 0.05 ; （ 120. 97 ± 78. 28,117.94 ± 75.81 vs. 174.45 ±92. 67） U/L,P 〈0.05] in IPC ＋ Postcon and Postcon groups than those in IR group. There was no significant difference between IPC ＋ Postcon group and Postcon group. MDA levels at admission of all patients were higher than that in normal control, that in IPC ＋ Postcon and Postcon groups was lower that in IR group at different time points after operation. After 8 weeks, WMSI of IPC ＋ Postcon and Postcon groups were much lower than that of IR group （ 1.16 ± 0. 12, 1.17 ± 0. 11 vs. 1.31 ± 0. 15, P 〈 0.05 ）. Conclusions Postcondi- tioning could improve coronary blood flow velocity and heart function, reduce free radical production as preconditioning. Both of them have no enhancement propety on the above effect .