远端缺血预处理在女性冠心病患者行择期PCI中对心脏的保护效果

Protective effect of remote ischemic preconditioning on cardiac function in female patients with coronary heart disease undergoing elective PCI treatment

目的:探讨远端缺血预处理(remote ischemic preconditioning,RIPC)在女性冠心病患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后的心脏保护效果。方法:随机将112例拟行择期PCI术的女性不稳定性心绞痛患者分为远端缺血预处理组(RIPC组)和对照组,最终纳入75例成功完成PCI术的女性不稳定性心绞痛患者,远端缺血预处理组36例,对照组39例;两组患者常规进行术前、术后静脉水化治疗,RIPC组患者在行PCI治疗前1 h单侧上肢血压计行4次每次阻断5 min,间隔5 min恢复循环,压力设为200 mm Hg或>收缩压50 mm Hg(高血压患者);对照组患者单侧上肢用血压计行4次每次阻断5 min间隔5 min恢复循环,压力设为10 mm Hg,检测两组患者术前及术后24 h的肌酸激酶同工酶MB(CK-MB)、心肌肌钙蛋白I(c Tn I)水平,分析复合心血管终点事件发生率。结果:缺血预处理组与对照组患者的主要基线指标比较,差异无统计学意义(P>0.05);RIPC组患者术后CK-MB、c Tn I水平较对照组降低(P<0.05);两组患者发生复合心血管终点事件24例,其中RIPC组6例(16.66%)、对照组18例(46.15%),RIPC组低于对照组(P<0.05)。结论:远端缺血预处理可降低女性冠心病患者择期PCI术后心肌损伤发生并可改善预后。

Objective：To investigate the cardioprotective effect of remote ischemic preconditioning （RIPC） after percutaneous coronary intervention （PCI） in fe- male patients with coronary artery disease. Method：112 female unstable angina pectofis patients undergoing elective PCI were randomly assigned to the remote ische- mic preconditioning group （RIPC） and the control group. Only 75 cases were successfully treated with PCI, 36 cases in the RIPC group and 39 cases in the control group. All patients were given conventional intravenous hydration treatment both before and after surgery. The RIPC group was given unilateral upper limb blood pres- sure 4 times and 5min blocking for each time with 5min recovery cycle, and the pressure was 200mmHg or higher than 50mmHg （systolic blood pressure in patients with hypertension） ; The control group was given unilateral upper limb blood pressure meter for4 times and 5min blocking each time with 5min recovery cycle, and the pressure was 10mmHg. CK - MB and cTnI levels before and 24h after operation in the two groups were measured in parallel, and the composite cardiovascular end- point events were analyzed. Results：There were no significant differences between the RIPC group and the control group in the main baseline indicators （ P 〉 0.05 ）, and the postoperative CK - MB and cTnI levels in the RIPC group were lower than those in the control group （ P 〈 0.05 ）.. There were 24 cases of combined cardio- vascular end events in the two groups, 6 cases in the RIPC group （ 16.66% ） and 18 cases in the control group （46.15 % ）, and the cases in the RIPC group was sig- nificantly lower than that in the control group （ P 〈0.01 ）. Conclusions：The remote ischemie preconditioning can reduce the myocardial damage and improve the prognosis after elective PCI surgery in female patients with coronary heart disease.