缺血后适应对老年急性心肌梗死患者的影响

Effect of ischemic postconditioning on elderly patients with acute myocardial infarction

目的观察缺血后适应(IPO)对急性心肌梗死(AMI)患者PCI后心肌灌注和临床事件的影响。方法选取12h内接受急诊PCI的老年AMI患者122例,分为对照组87例和IPO组35例。对照组梗死相关血管再通后,不施加干预;IPO组梗死相关血管再通后1 min内应用低气压充盈和回撤球囊,每一过程各30s,术后测定血肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、丙二醛,观察ST段回落,冠状动脉血流速度、住院期间临床事件发生情况。结果 IPO组CK、CK-MB和丙二醛峰值明显低于对照组(P<0.05);IPO组冠状动脉血流速度明显快于对照组(P<0.05),术后ST段回落>50%者明显高于对照组(74.3%vs 54.0%,P<0.05),再灌注心律失常发生率明显低于对照组(P<0.05)。结论 IPO可以缩小心肌梗死面积、减少自由基的生成,改善PCI后冠状动脉血流速度,改善心肌灌注,减少再灌注心律失常的发生。

Objective To explore the effect of ischemic postconditioning（IPO） on myocardial reperfusion and clinical events in patients with AMI after intervention treatment. Methods 122 patients with AMI undergoing emergency percutaneous coronary intervention were divided into control group （n = 87） and IPO group （n = 35） within 12 hours after admission. In the control group,no intervention was given at the onset of reperfusion,while in the IPO group,three cycles of repetitive angioplasty balloon inflation and deflation were performed within 1 minute after reperfusion. Creatine phosphate kinase （CK）, CK-MB, malondialdehyde （MDA）, ST segment regression,corrected TIMI frame count （CTFC）, incidence of reperfusion arrhythmias and clinical events were analyzed for all patients after the procedure. Results CK, CK-MB and MDA peak value were lower[（1179. 7±992. 3） U/L vs （1643.5±1021.3） U/L, P 〈 0. 05;（120. 5±76. 6） U/L vs （160.3±88.6） U/L; （7.0±2.2） umol/L vs （9.7±2.3） umol/L; P〈 0.05] in IPO group than in control group. The frequency of ST segment resolution 〉 50% was higher （74. 3% vs 54.0%） and CTFC was faster（26.7±11.2 vs 31.4±9.5, P〈 0.05） in IPO group than in control group. The incidence of reperfusion arrhythmia was lower in IPO group than in control group. Conclusions IPO can reduce infarct area size and free radical production,improve coronary blood flow velocity and myocardial reperfusion, reduce incidence of reperfusion arrhythmias.