慢性冠状动脉供血不足患者PTCA术前后外周血心肌酶和白细胞的变化及意义

The changes and its meaning of peripheral WBC and myocardial enzyme after PTCA for chronic myocardial ischemia

目的探讨经皮腔内冠状动脉成形术（ＰＴＣＡ）是否对慢性冠状动脉供血不足产生缺血及再灌注损伤。方法 选择行ＰＴＣＡ的慢性冠心病患者１８例为观察组（ＰＴＣＡ组），怀疑有冠心病行选择性冠状动脉造影（ＳＣＡ）患者２０例作对照组（ＳＣＡ组），观察血清心肌酶ＣＫ－ＭＢ、ＬＤＨ、外周血白细胞计数（ＷＢＣ）及中性粒细胞百分比（ＰＭＮ％）在手术前后的变化。结果 所有ＰＴＣＡ均成功，术后残余狭窄均小于１５％。手术后上述指标与术前相比两组均有明显升高（Ｐ＜０．０５），但术后两组间比较，尽管ＰＴＣＡ组ＣＫ－ＭＢ、ＷＢＣ、ＰＭＮ％较对照组有升高趋势，但无统计学差异（Ｐ＞０．０５）。结论 ＰＴＣＡ对慢性冠状动脉供血不足不产生显著的缺血及再灌注损伤，但不能排除轻微的损伤作用，这种损伤不仅与ＰＴＣＡ中球囊扩张的时间，球囊的压力及基础病变有关，还与心肌组织的病理生理状态有关，对不稳定性心绞痛病人ＰＴＣＡ可能增加缺血及再灌注损伤的机会和程度。

Objective In order to study whether PTCA aggrevates myocardial ischemia and induces reperfusion injury or not Methods : 8 cases of coronary heart disease (CAD) were selected for pereutanous coronary angioplast (PTCA) as PTCA group; 20 cases were suspects of coronary heart disease for selective coronary angiography (SCA) as SCA group. Serum myocardiac enzyme CK-MB.LDH and peripheral WBC were observed before and after operation (PTCA and SCA). Results All PTCA were successfully performed, all residual stenoses were less than 15%. All indices of two groups were higher after operation than that before (p < 0.05). but there were not significantly statistical differences between two groups after operation(P > 0. 05) Conclusions PTCA neither aggrevates seriously myocardial ischemia nor induce obvious reperfusion injury. But it does not deny mild injury effect on PTCA. ms mild injury is related to at only inflation for, pressure and basic pathomorphology but also pathophysiologic state of myocardium. PICA for unstable angia pectoris probably increase the chance and the degree of myocardial ischemia and reperfusion injury.