急性心肌梗死PCI术中缺血后适应的临床意义

Clinical value of ischemia postconditioning during primary PCI in patients with acute myocardial infarction

目的探讨缺血后适应对减轻缺血-再灌注损伤的临床价值。方法76例急性心肌梗死(AMI)行急诊经皮冠状动脉介入(PCI)术患者分为缺血后适应(PC)组(36例)和未实施缺血后适应对照(C)组(40例)。PC组在再灌注早期给予反复短暂再通/闭塞的PC 4次;对比观察两组PCI前后肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌酐(Cr)以及左心射血分数(LVEF)等的动态变化。结果PC组再灌注心律失常发生率明显低于C组(22.2%vs.47.5%,P<0.05),术后CK、CK-MB和Cr水平也显著低于C组(P<0.05或P<0.01);住院时间及PCI术后LVEF两组间无统计学差异(P>0.05)。结论PCI时行PC处理能降低再灌注心律失常发生率,减少心肌梗死面积,保护肾脏功能。

Objective To investigate the value of ischemia postconditioning （PC） in patients with acute myocardial infarction （AMI） undergoing emergency percutaneous coronary intervention （PCI）. Metheds Seventy-six patients with AMI underwent revascularization by primary PCI within 12 h after the onset. The 36 patients in group PC were given 4 times of ischemia postconditioning （one min reperfusion followed by one rain occlusion）, and the other 40 cases were not given ischemia posteonditioning as the controls（group C）. The dynamic changes of creatine phosphokinase （CK）, CK-MB, serum creatinine （Cr） and left ventricular ejection fraction （LVEF） were measured and compared. Results The morbidity of reperfusion arrhythmia was signifcantly lower in group PC than that in group C （22.2% vs. 47.5%） （P〈0.05）. The levels of CK,CK-MB and Cr were lower in group PC than those in group C after PCI （P〈0.05 or P〈0.01）. There were no significant differences in hospital stay and LVEF between the two groups after PCI. Conelution Ischemia postconditioning early after PCI may significantly reduce the incidence of reperfusion arrhythmia and infarct size, and protect renal function.