远程肢体缺血预适应对急性心肌梗死患者冠状动脉侧支循环的影响

The effect of remote limb ischaemic preconditioning on coronary collateral circulation in patients with acute myocardial infarction undergoing selective percutaneous coronary intervention

目的探讨远程肢体缺血预适应(LIP)对急性ST段抬高型心肌梗死(STEMI)择期经皮冠状动脉介入治疗(PCI)患者冠状动脉侧支循环的影响。方法连续选择2018年3月至2019年9月于粤北人民医院因错过再灌注时间窗而行择期PCI术的STEMI患者130例。其中随机选择65例为预适应组行远程肢体缺血预适应[PCI术前3 d开始使用缺血预适应训练仪行双上肢缺血预适应,袖带加压高于基础血压50 mmHg(1 mmHg=0.133 kPa)压迫肱动脉,持续5 min后放气休息间隔5 min,重复5次,早晚各执行一组];余65例为对照组,术前不行远程缺血训练。比较两组PCI术中侧支循环发生率及级别水平(0~3级)。根据侧支循环级别重新分组,以侧支循环2~3级为侧支循环良好组,0~1级为侧支循环不良组,跟踪两组1年不良事件发生率。结果按侧支循环Rentrop分级标准,评价两组患者术中侧支循环分级情况。预适应组与对照组的平均侧支等级比较[(1.60±0.24)级比(0.83±0.18)级,P=0.024],差异有统计学意义。预适应组侧支循环分级为0级的患者占比远低于对照组(29.2%比53.8%),而侧支循环分级为3级的患者占比远高于对照组(35.4%比10.8%)。两组侧支循环分级的分布情况比较,差异有统计学意义(P=0.003)。K-M生存曲线提示,侧支循环良好组较侧支循环不良组主要不良心血管事件发生率明显下降(P<0.05)。结论远程肢体缺血预适应对STEMI择期PCI患者冠状动脉侧支循环的形成有促进作用,可改善患者术后1年预后。

Objective To investigate the eff ect of remote limb ischaemic preconditioning(LIP)on coronary collateral circulation in patients with STEMI undergoing selective percutaneous coronary intervention(PCI).Methods In the study,130 patients with STEMI undergoing selective PCI because of missing revascularization time window were consecutively enrolled between March 2018 and September 2019 admitted in our hospital.The patients were divided into two groups randomly.The LIP group of 65 patients were accepted LIP(5-minute infl ations of 50mmHg higher than basal blood pressure around the tow upper arms,followed by 5-min intervals of reperfusion,repeat 5 times and twice daily)3 days before PCI,while the control group underwent PCI directly.The incidence and level(0-3)of coronary collateral circulation during PCI were compared between the two groups.The patients were categorized based on the level of coronary collateral circulation(level 2-3 as good collateral circulation group and level 0-1 as poor collateral circulation group),and the rate of adverse events were follow up for 1 year.Results The collateral circulation was evaluated in two group based on Rentrop criteria.Compared with the control group,the mean level was signifi cantly better in LIP group[(1.60±0.24)vs.(0.83±0.18),P=0.024].Compared with the control group,the number of patients with level 0 in coronary collateral circulation were signifi cantly less in LIP group(29.2%vs.53.8%,P=0.035),while the number of patients with level 3 were signifi cantly more in LIP group(35.4%vs.10.8%,P=0.014).There was no signifi cant diff erence in the number of patients with level 1 or 2 between the two groups(both P>0.05).K-M survival curve indicated that the incidence of adverse events in the group with good collateral circulation was signifi cantly lower than that in the group with poor collateral circulation(P<0.05).Conclusions LIP can promote the formation of coronary collateral circulation in patients with elective PCI in STEMI and improve the prognosis of patients within 1 year.