肢体缺血后处理对直接冠状动脉介入治疗心肌再灌注损伤的干预研究

Intervention of limb ischemic postconditioning on myocardial ischemia-reperfusion injury in primary percutaneous coronary intervention

目的:用肢体缺血后处理的方法,干预直接经皮冠状动脉介入治疗(PCI)急性ST段抬高型心肌梗死(STEMI),以减轻心肌缺血再灌注损伤。方法:对拟行直接PCI的急性STEMI患者62例,用随机数字法分为肢体缺血后处理(LIPost)组30例和常规对照(NC)组32例。LIPost组在球囊首次扩张梗死相关血管(IRA)前,用血压计袖带缠绕于上臂并充气达250mmHg(1mmHg=0.133kPa),持续5min后放气,间隔5min后重复1次;NC组不作预处理。比较2组术后IRA心肌梗死溶栓试验血流分级(TIMI)、梗死相关区域(IRZ)心肌呈色分级(MBG)、ST段抬高回落指数(STR)、再灌注心律失常(RA)和心肌钙蛋白I(cTnI)峰值前移的发生率,以及症状至球囊扩张时间(SOTB)。结果:2组患者的主要基线指标无统计学差异。2组患者IRA前向血流达TIMI 3级和cTnI峰值前移的获得率相似(96.7%∶96.9%,P=1.000;93.3%∶84.4%,P=0.476),差异无统计学意义。与NC组相比,LIPost组MBG≥2级和STR≥50%获得率较高(80.0%∶56.3%,P=0.046;83.3%∶59.4%,P=0.038),差异有统计学意义;RA发生率较低(30.0%∶56.3%,P=0.037),差异有统计学意义。2组SOTB相似(6.4±3.3∶5.6±3.0,P=0.339),差异无统计学意义。结论:急性STEMI直接PCI时,肢体缺血后处理可有效减轻心肌再灌注损伤,且不影响症状至球囊扩张时间。

Objective：To explore the effection of limb ischemic postconditioning（LIPost） on myocardial ischemia-reperfusion injury after primary percutaneous coronary intervention（PCI） in patients with ST elevation acute myocardial infarction（STEMI）.Method：The 62 patients with STEMI who underwent primary PCI were randomly assigned to LIPost group（n=30） and control group（n=32）.In the LIPost group,sphygmomanometer cuff wrapped around upper arm of each patient was inflated to 250mmHg for 5 minutes and deflated 5 minutes two times before primary PCI,the other procedures were the same as control group.Result：Patients were well-matched with no significant differences at baseline in majority measured parameters between two groups.The rate of infarct-related artery（IRA） thrombolysis in myocardial infarction（TIMI） grade 3 and forward cardiac troponin I（cTnI） peak were not significantly different between two groups（96.7%∶96.9%,P=1.000;93.3%∶84.4%,P=0.476）. Compared with that of control group.The rate of Infarct-related zone（IRZ） myocardial blush grade（MBG）≥2 and ST-segment elevation resolution（STR）≥50% increased significantly（80.0%∶56.3%,P=0.046;83.3%∶59.4%,P=0.038）;the incidence of reperfusion arrhythmias（RA） decreased significantly（30.0%∶56.3%,P=0.037） in the LIPost group.The symptom-onset-to-balloon （SOTB） time had no significant difference between two groups（6.4±3.3∶5.6±3.0,P=0.339）.Conclusion：Limb ischemic postconditioning effectively reduces myocardial ischemia-reperfusion injury after primary PCI in patients with STEMI,and does not affect the symptom-onset-to-balloon time.