远端缺血预处理对择期行介入治疗的缺血性心脏病患者心肌损伤及预后的影响

Effect of remote ischemic preconditioning on myocardial damage and outcome in ischemic heart disease patients after PCI

目的探讨远端缺血预处理对择期行PCI患者的心肌保护作用及远期预后影响。方法选择择期行PCI的缺血性心脏病患者122例,采用随机对照表法分为观察组和对照组,各61例。2组均常规药物治疗,观察组在PCI术前1 h予远端缺血预处理30 min。观察2组患者术后16 h高敏肌钙蛋白Ⅰ(hs-cTnⅠ)> 0. 12、> 0. 16、> 0. 20、> 0.24、> 0. 28、> 0. 36和> 0. 48μg/L所占比例及4a型心肌梗死发生率,随访6和12个月时再发心绞痛、再发心肌梗死和死亡等主要不良心血管事件发生情况。结果观察组不同hs-cTnⅠ水平比例均明显低于对照组(> 0. 12μg/L,54. 1%vs 78. 7%,P=0. 004;> 0. 16μg/L,49. 2%vs 68. 9%,P=0. 039),观察组4a型心肌梗死发生率显著低于对照组(41. 0%vs 59. 0%,P=0. 046)。术后6个月随访时,观察组较对照组再发心绞痛和再发心肌梗死发生率虽有下降,但差异无统计学意义(9. 8%vs 21. 3%,χ~2=3. 055,P=0. 080; 0 vs 3. 3%,χ~2=2. 033,P=0. 154),术后12个月随访时,观察组较对照组再发心绞痛和再发心肌梗死发生率明显下降(13. 1%vs 32. 8%,χ~2=6. 675,P=0. 010;1. 6%vs 11. 5%,χ~2=4. 816,P=0. 028)。2组随访期间均无死亡患者。结论远端缺血预处理可显著降低择期行PCI患者术后hs-cTnⅠ水平,保护心肌,降低4a型心肌梗死发生率,并改善患者预后。

Objective To study the effect of remote ischemic preconditioning on myocardial damage and outcome in ischemic heart disease( IHD) patients after PCI. Methods One hundred and twenty-two IHD patients scheduled for PCI were randomly divided into observation group( n = 61) and control group( n =61). The patients received conventional drug therapy. The brachial artery of patients in observation group was compressed with the cuff of a sphygmomanometer untill its blood presessure reached 200 mm Hg that can block the blood fow in upper extremity for 5 minutes and the blood flow was restored after 5 minutes of decompression at 1 h before PCI,which was repeated 3 times for 30 minutes. The serum hs-cTnⅠ levels were measured,which were > 0. 12 μg/L, > 0. 16 μg/L, > 0. 20 μg/L, > 0. 24 μg/L, > 0. 28 μg/L, >0. 36 μg/L and > 0. 48 μg/L. The incidence of 4 a myocardial infarction was recorded at 16 h after PCI.The patients were followed up for 6 and 12 months,during which the MACE( including the recurrence of angina pectoris and myocardial infarction) were recorded. Results The serum hs-cTnⅠ levels and the incidence of 4 a myocardial infarction were significantly lower in observation group than in control group( 41. 0% vs 59. 0%,P = 0. 046). No significant difference was found in the recurrence rate of angina pectoris and myocardial infarction between the two groups at month 6 follow-up after PCI( 9. 8% vs 21. 3%,χ~2= 3. 055,P = 0. 080;0 vs 3. 3%,χ~2= 2. 033,P = 0. 154). The recurrence rate of angina pectoris and myocardial infarction was significantly lower in observation group than in control group at month 12 follow-up after PCI( 13. 1% vs 32. 8%,χ~2= 6. 675,P = 0. 010;1. 6% vs 11. 5%,χ~2= 4.816,P = 0. 028). No death occurred in two groups during the 6 months and 12 months follow-up periods.Conclusion Remote ischemic preconditioning can significantly downregulate the serum hs-cTnⅠ level,protect the myocardium,reduce the incidence of 4 a myocardial infarction,and improve the outcome in IHD patients.