缺血后适应对急性前壁心肌梗死患者心功能的保护作用

PROTECTION OF ISCHEMIC POSTCONDITIONING IN ACUTE ANTERIOR MYOCARDIAL INFARCTION TREATED BY PERCUTANEOUS CORONARY INTERVENTION

目的探讨缺血后适应(ischemic postconditioning,IPC)对PCI治疗的急性前壁心肌梗死患者的心肌保护作用。方法选择直接PCI的首次急性前壁心肌梗死AMI患者196例,依据再灌注开始3min内,是否给予30s再灌注/30s再闭塞的3次循环,随机分为IPC组和常规PCI组。监测二组患者术前至术后1周血脑钠肽(brain natriuretic peptide,BNP)水平变化,术前、术后1个月、术后12个月行超声心动图检查,应用双平面simpson法测定左室射血分数(left ventricular ejection fraction,LVEF),对左心室收缩功能进行评估。依据随访12个月时测得的LVEF是否大于45%将患者分成二组:LVEF值作为因变量,从具有统计学意义的指标中提取的候选参数作为自变量,进行Logistic回归分析。结果二组患者血BNP水平术前比较差异无统计学意义,术后24h及第七天各时间点比较差异有统计学意义(P<0.05);二组患者LVEF术前比较差异无统计学意义(P>0.05),术后1个月及12个月比较差异有统计学意义(P<0.05);Logistic回归分析发现影响AMI患者PCI术后远期心功能的独立危险因素包括后适应实施与否。结论 (1)缺血后适应在急性前壁心肌梗死直接冠脉成形术中,可降低心室壁张力,通过改善左心室心肌重构,提高左心室收缩功能。(2)缺血后适应作为独立危险因素影响急性前壁心肌梗死患者PCI术后的心功能。

Objective To evaluate the protection of ischemic postconditioning （IPC） to reperfusion myocardial in acute anterior,myocardial infarction treated by percutaneous coronary intervention （PCI}. Methods A total of 196 cases with first- time acute anterior myocardial infarction undergoing emergency PCI were enrolled in the study. After reperfusion, according to whether implemen^s 30 - second - perfusion/Occlusion for 3 times in the following 3 minutes,they were randomly sorted into IPC and conventional PCI group. Monitoring BNP before and until 1 week later after PCI, echocardiographic examination was conducted before, 1 month and 12 months after operation,detecting left ventricular systolic function by LVEF measured by ultrasonic biplane Simpson method. Patients were sorted into two groups according whether their LVEF＇s cutoff point （more than 45% or not） in 12 month. Logistic regression analysis was carried out,value of LVEF is dependent variable, from the statistically significant indexes to extract candidate parameters as independent variables. Results There was not statistically significant in BNP and LVEF before PCI （P〉0.05） ,but there was statis- tical significance for BNP between the two groups 24hs and 1 week after PCI （ P〈0.05）, as well as for LVEF one month and 12 months later after PCI （P〈0.05）. From logistic regression analysis we found that the independent risk factors for the development of cardiac function in AMI patients after PCI include implementing IPC or not.Conclusion Ischemic postconditiorting in acute anterior myocardial infarction can improve left ventricular systolic function by reducing left ventricular wall tension and improving the left ventricular myocardial remodeling. IPC as an independent risk factor can influence patient＇s cardiac function that is treated by percutaneous coronary intervention.