缺血后处理对急性心肌梗死介入治疗患者的心脏保护作用

Cardioprotective effects of ischemic postconditioning on patients with acute myocardial infarction accepted for interventional therapy

目的探讨缺血后处理(I-postC)对接受急诊介入治疗的急性心肌梗死(AMI)患者的心脏保护作用。方法检索1998年1月至2011年5月各中文医学数据库中关于AMI患者接受急诊介入治疗过程中应用I-postC的文献。进行文献筛选和质量评价后,利用RevMan4.2软件进行Meta分析。结果共纳入文献7篇,总病例数为519例,其中I-postC组234例,对照组285例。与对照组比较,I-postC能明显降低AMI患者的肌酸激酶(CK)酶峰(WMD:-356.72IU/L,95%CI:-541.33～-199.11IU/L,P<0.000 01)、肌酸激酶MB型同工酶(CK-MB)酶峰(WMD:-39.45IU/L,95%CI:-54.53～-24.37IU/L,P<0.000 01)以及再灌注心律失常的发生(OR:0.41,95%CI:0.25～0.66,P=0.000 3),并改善AMI患者左心室射血分数(LVEF)(WMD:0.03,95%CI:0.02～0.03,P<0.000 01)。结论 I-postC对缺血心脏有明显的保护作用,具有较大的临床应用价值。

Objective To explore cardioprotective effects of ischemic postconditioning（I-postC） on patients with acute myocardial infarction who had accepted emergency interventional therapy.Methods Literature from January 1998 to May 2011 related to I-postC application in patients with AMI who had accepted emergency interventional therapy were searched in all Chinese medical databases.After literature screening and quality assessment,RevMan 4.2 software was utilized for Meta-analysis.Results A total of 7 literatures were enrolled with total 519 cases.234 cases of them were in I-postC groups and 285 cases in control groups.Compared with control group,I-postC significantly reduced the creatine kinase（CK） peak value（WMD：-356.72 IU/L,95%CI：-514.33——199.11 IU/L,P0.000 01）,creatine kinase MB isoenzyme（CK-MB） peak value（WMD：-39.45 IU/L,95%CI：-54.53——24.37 IU/L,P0.000 01） and occurrence of reperfusion-induced arrhythmia（OR：0.41,95%CI：0.25-0.66,P=0.000 3） in patients with AMI.I-postC was also found to improve left ventricular ejection fraction（LVEF） of patients with AMI（WMD：0.03,95%CI：0.02-0.03,P0.000 01）.Conclusion I-postC possesses significantly protective effect on ischemic heart with great value in clinical application.