缺血后处理对右冠状动脉闭塞再灌注损伤的影响

Cardioprotective effects of ischemic postconditioning on reperfusioninjury in patients with right coronary artery occluded

目的:探讨缺血后处理对急性右冠状动脉(右冠)闭塞再灌注损伤的影响。方法:将诊断为急性ST段抬高心肌梗死(SETMI)并在12h内接受冠状动脉介入治疗(PCI)的79例右冠闭塞患者,随机分为对照组(38例)及缺血后处理组(41例)。对照组给予单纯再灌注治疗;缺血后处理组采用在开通血管前1min内开始再灌注30s再缺血30s,交替4次后再持续灌注的方法。比较两组再灌注心律失常的发生率、心肌酶峰值、冠状动脉血流速度(CTFC)。结果:对照组和缺血后处理组再灌注心律失常——频发室性期前收缩发生率分别为34.2%和9.8%(P=0.013),显著窦性心动过缓发生率分别为47.4%和19.5%(P=0.016),窦性停博发生率分别为18.4%和2.4%(P=0.025),二度以上房室传导阻滞的发生率为36.8%和12.2%(P=0.017);心肌酶峰值:CK分别为(2 143±834)μ/L和(1 879±683)μ/L(P<0.05),CK-MB分别为(289±89)μ/L和(176±93)μ/L(P<0.05)。CTFC分别为(34±8)帧和(25±6)帧(P<0.05)。结论:心肌缺血后处理短期内能显著减轻急性右冠闭塞患者心肌再灌注损伤,有显著的心肌保护作用。

Objective： To explore whether ischemic postconditioning could protect the heart in patients with right coronary artery occluded. Method.. A total of 79 patients were submitted to primary percutaneous coronary in- tervention for right coronary artery occluded in 12 hours. They were randomly divided into control group （n=38） and postconditioning group （n = 41）. The control group reflowed hy direct stenting. The patients in postcondition- ing group were performed within 1 minute of reflow by 4 episodes of 30 seconds inflation and 30 seconds deflation with the angioplasty balloon before a final longer period of reperfusion. The reperfusion arrhythmias, creatine kinase peaks, corrected TIMI frame count were analyzed for all patients after the procedure. Result：The incidence of reperfusion arrhythmias： ventricular premature （34.2% vs 9.8%, P= 0.013）, bradycardia （47.4% vs 19.5%, P= 0. 016）, sinus arrest （18.4% vs 2.4%, P = 0. 025） and II -- III degree atrioventricular block （36.8% vs 12.2%, P=0. 017）. The creatine kinase peak in postconditioning group was lower than that in control group, CK[（2 143±834）U/L vs （1 879±683）U/L, P〈0.05]; CK-MB：[（289±89）U/L vs （176±93）U/L, P〈0.05]. Corrected TIMI frame count was significantly increased in postconditioned group compared with con- trol [（34±8） vs （176±93）, P〈0.05]. Conclusion： Ischemic postconditioning reduces arrhythmias-frequent as well as infarct size, and improves the infarcted related artery blood flow.