缺血后处理对改善老年人急性心肌梗死再灌注损伤心肌血流灌注的疗效分析

Cardioprotective effects of ischemic post-conditioning in the elderly with acute myocardial reperfusion injury

目的探讨缺血后处理对老年急性ST段抬高型心肌梗死（STEMI）患者再灌注损伤的保护作用。方法连续选择发病12h内行直接经皮冠状动脉介入治疗（PCI）的急性STEMI患者215例，数字抽签法随机分为缺血后处理组和常规治疗组（对照组），两组年龄65岁及以上患者分别为38例和46例。对照组给予单纯再灌注治疗，缺血后处理组采用再灌注30s，再缺血30s，交替3次后再持续灌注的方法。分别评估缺血后处理对老年患者再灌注心律失常的发生率、冠状动急性心肌梗死溶栓试验（TIMI）血流分级和心肌组织水平灌注等指标的影响。结果缺血后处理组和对照组再灌注心律失常发生率分别为21．1％（8／38）和45．7％（21／46），差异有统计学意义（χ2=5．571，P〈0．05）；其中高危、需要药物或电转复及临时起搏等于预的心律失常发生率分别为7．9％（3／38）和26．1％（12／46），差异有统计学意义（χ2=4．695，P〈0．05）。校正的TIMI血流帧数（cTFC）分别为（23．64±3．7）帧和（26．1±5．9）帧（t=5．434，P〈0．05）。TIMI心肌灌注分级（TMPG）3级分别为89．5％（34例）和69．6％（32例），差异有统计学意义（χ2=4．899，P〈0．05）。结论心肌缺血后处理能减轻老年STEMI患者心肌再灌注损伤，可应用于老年人STEMI再灌注损伤的防治。

Objective To study the cardioprotective effects of ischemic post-conditioning on elderly patients with ST-elevation acute myocardial infarction （STEMI）. Methods Consecutive 215 patients with STEMI undergoing emergency percutaneous coronary intervention（PCI） were randomly assigned to receive ischemic post-conditioning or conventional PCI treatment. The ischemic postconditioning （n=38） were conducted by 3 episodes of 30-second occlusion followed by 30-second reperfusion, while the control group （n= 46） was without any intervention after PCI. Reperfusion arrhythmias, corrected TIMI frame count （cTFC） and TIMI myocardial perfusion grade （TMPG） were compared between the two groups, respectively. Results The incidence of reperfusion arrythmias was less frequent in ischemic postconditioning group （21.1 % ,8/38） than in control group （45.7% ,21/46） after PCI （χ2 = 5. 571, P〈0.05）. The TIM1 grade 3 flow was similar between two groups [（94.7%（36/38） vs. 82.6%（38/46）, χ2= 2. 919, P〉0. 053, the cTFC levels （23.6±3.7 vs. 26.1 ± 5.9） and TMPG 3 perfusion （ 89.5% （34/38） vs. 69.6o//oo （32/46）3 were significantly different （t=5.434, P〈0.05; χ2 =4.899, P〈0.05, respectively） between two groups. Conclusions Ischemic postconditioning may reduce myocardial reperfusion injury in elderly patients with STEMI undergoing emergent PCI.