肢体缺血预处理预防经皮冠状动脉介入治疗围术期心肌坏死

Prevention on myocardial necrosis with limb ischemic preconditioning in percutaneous coronary intervention

目的探讨用肢体缺血预处理的方法预防经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗患者围术期心肌坏死。方法将拟行择期PCI治疗的慢性稳定性心绞痛患者63例,经随机数字法分为预处理组(31例)及对照组(32例)。预处理组患者于术前用血压计袖套缠绕于上臂并充气达250mm Hg(1mm Hg=0.133kPa),持续5min后放气,重复3次,每次间隔5min,然后送导管室行PCI治疗;对照组不作预处理直接送到导管室行PCI治疗。入院时及术后12h查血清肌钙蛋白I(cardiac troponin I,cTnI)浓度并进行比较。结果两组主要基线资料比较,差异无统计学意义(P>0.05)。两组PCI治疗后12h血清cTnI浓度均比术前增高,差异有统计学意义[(0.022±0.016)ng/mL vs.(0.012±0.006)ng/mL,P<0.01;(0.035±0.034)ng/mL vs.(0.010±0.005)ng/mL,P<0.01]。与对照组相比,预处理组PCI治疗后12h血清cTnI浓度较低,差异有统计学意义[(0.022±0.016)ng/mL vs.(0.035±0.034)ng/mL,P=0.048]。围术期心肌坏死的发生率预处理组为12.9%(4/31),对照组为34.4%(11/32),预处理组围术期心肌坏死发生率较对照组低,差异有统计学意义(12.9%vs.34.4%,P=0.045)。结论肢体缺血预处理可以降低PCI治疗围术期心肌坏死发生率,有一定的预防围术期心肌坏死作用。

Objectives To evaluate the preventative effect of myocardial necrosis with limb ischemic preconditioning in percutaneous coronary intervention. Methods We randomly assigned 63 patients who underwent percutaneous coronary intervention （PCI） to limb ischemic preconditioning （LIP） group （n=31） and control group （n=32）. In LIP group, sphygmomanometer cuff wrapped around upper arm of each patient was inflated to 250 mm Hg（ 1 mm Hg=0.133 kPa） for 5 minutes and deflated 5 minutes for 3 times before PCI, the other procedures were the same as control group. Patients in control group hadn＇t been done any preconditioning and were directly sent to perform PCI. Blood samples were collected from peripheral vein before PCI and 12 hours after PCI to measure the concentration of cardiac troponin I （eTnI）. Results Patients were well-matehed with no significant difference at baseline in majority measured parameters between two groups（P〉0.05）. The cTnI, 12 hours after PCI, increased significantly compared with the cTnI from baseline in the two groups[ （0.022±0.016）ng/mL vs. （0.012±0.006）ng/mL,P〈0.01 ; （0.035±0.034）ng/mL vs. （0.010±0.005）ng/mL,P〈0.01 ]. Compared with control group, serum concentration of cTnI decreased significantly 12 hours after PCI [ （0.022±0.016）ng/mL vs. （0.035±0.034）ng/mL,P=0.0483. The incidence rate of perioperative myocardial necrosis was 12.9% （4/31 ） in LIP group and 34.4% （ 11/32 ） in eontrol group. Incidence rate of perioperative myocardial necrosis in LIP group was significantly lower than that in control group （12.9% vs.34.4% ,P=0.045）. Conclusions Incidence rate of perioperative myocardial necrosis was decreased significantly by limb ischemic preconditioning in PCI.