高压氧联合经皮冠状动脉介入术对不稳定心绞痛患者血液流变的影响及对心肌损伤的保护作用研究

Effect of hyperbaric oxygen therapy combined with percutaneous coronary intervention on blood rheological properties in patients with unstable angina and its protective effect on myocardial injury

目的探究高压氧联合经皮冠状动脉介入(PCI)术对不稳定心绞痛患者血液流变的影响及对心肌损伤的保护作用。方法选取河南大学第一附属医院心内科2017年6月至2018年12月168例不稳定心绞痛患者作为研究对象,采用随机数字表法分为对照组(54例)和观察组(54例)。对照组给予常规PCI术及对症支持治疗,实验组在对照组治疗基础上再联合高压氧治疗(1次/d,10 d为1个疗程,共治疗2个疗程)。比较2组患者临床治疗效果,并检测治疗前后患者血液流变学指标及心肌损伤标志物的变化情况。结果观察组患者显效45例,有效34例,总有效率为94.05%,显著高于对照组的84.52%,差异有统计学意义(P<0.05)。治疗后,观察组患者氧分压(PaO_(2))明显升高,二氧化碳分压(PaCO_(2))显著下降,血氧代谢改善情况明显优于对照组,差异有统计学意义(P<0.05)。观察组患者血液流变学相关指标全血黏度(whole blood viscosity,ηb)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、红细胞比容(hematocrit,HCT)、红细胞电泳时间(erythrocyte electrophoresis time,EET)、红细胞聚集指数(erythrocyte aggregation index,EAI)及血小板聚集率(platelet aggregation rate,PAgT)水平明显下降,且改善情况显著优于对照组,差异有统计学意义(P<0.05)。2组患者血小板活化指标人溶血磷脂酸(lysophospholipids acid,LPA)及血小板活化因子P-选择素(platelet activation factor P-select element,CD62P)均明显降低,且观察组患者LPA及CD62P降低水平优于对照组,差异有统计学意义(P<0.05)。同时,2组患者心肌肌钙蛋白I(cardiac troponin I,cTnⅠ)和肌酸激脢-MB(creatine kinase-MB,CK-MB)水平均升高,但观察组心肌损伤标志物cTnI及CK-MB低于对照组,差异有统计学意义(P<0.05)。结论高压氧辅助治疗通过增加机体组织血氧含量可有效降低血液黏度,改善血液流变性,减少血小板活化,防止血栓形成,同时还能有效减轻心肌损伤,提高临床治疗效果。

Objective To explore the effect of the hyperbaric oxygen therapy combined with percutaneous coronary intervention(PCI)on blood rheological properties in patients with unstable angina and its protective effect on myocardial injury.Methods A total of 168 cases of patients with unstable angina admitted to Department of Cardiovascular Medicine of the First Affiliated Hospital of Henan University from June 2017 to December 2018 were selected as research subjects and divided into control group(84 cases)and observation group(84 cases).The control group was given conventional PCI,and symptomatic and supportive treatment,while the observation group were given hyperbaric oxygen therapy(1 time/day,10 days constitute one treatment course,2 courses in total)on the basis of the treatments in the control group.The clinical efficacy was compared between the two groups.The changes in blood rheological indexes and myocardial injury markers of the patients were detected before and after treatment.Results In the observation group,there were 45 cases with markedly efficacy,and 34 cases showed some efficacy.The total effective rate was 94.05%,which was significantly higher than that of 84.52% in the control group.The difference was statistically significant(P<0.05).After treatment,the PaO_(2) of the patients in the observation group significantly increased,while the PaCO_(2) significantly decreased.The improvement of the blood oxygen metabolism was more significant than that in the control group(P<0.05).Meanwhile,the levels of blood rheological indexes,e.g.whole blood viscosity(ηb),erythrocyte sedimentation rate(ESR),hematocrit(HCT),erythrocyte electrophoresis time(EET),erythrocyte aggregation index(EAI),and platelet aggregation rate(PAgT),in the two groups all declined obviously,and those in the observation group had greater decline than those in the control group(P<0.05).The lysophospholipids acid(LPA)and platelet-activating factor P-selectin(CD62P)in the two groups significantly decreased,and the levels of LPA and CD62P in the observation group had greater decreases than those in the control group(P<0.05).Moreover,the levels of the markers of myocardial injury,e.g.cardiac troponin I(cTnI)and creatine kinase-MB(CK-MB)in both groups increased significantly,and the cTnI and CK-MB levels in the observation group were significantly lower than those in the control group.Conclusion Through increasing blood oxygen content in body tissues,hyperbaric oxygen can effectively reduce blood viscosity,improve blood rheological properties,and therefore,reduce platelet activation,thus preventing thrombosis.It can also reduce myocardial injury and enhance the clinical efficacy for patients with unstable angina.