优化缺血后适应在STEMI患者PPCI术中的临床研究

Clinical study of optimized ischemic postconditioning during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

目的观察优化缺血后适应(IPoC)术式在急性ST段抬高型心肌梗死(STEMI)患者行直接经皮冠状动脉介入治疗(PPCI)术中对心肌缺血再灌注损伤(MIRI)的影响及意义,探索最佳缺血后适应术式。方法选择2018年6月—2020年3月在青岛市第八人民医院心内科住院诊断为STEMI并行PPCI术患者150例,随机分为对照组(50例)、IPoC组(50例)及优化IPoC组(50例)。对照组进行常规PCI治疗;IPoC组在开通梗死相关血管(IRA)后,给予常规缺血后适应处理,再置入支架;优化IPoC组在开通IRA后,给予优化缺血后适应处理,再置入支架。比较三组患者血清CTnT、NT-ProBNP、Hs-CRP水平,术中再灌注心律失常发生率,术后24 h心电图ST段回落比例,心脏超声LVEF等指标,及术后主要不良心血管事件发生率。结果术后CTnT、NT-ProB⁃NP、Hs-CRP水平,术中再灌注心律失常发生率,术后24 h ST段回落比例,心功能恢复等方面,优化IPoC组及IPoC组均明显优于对照组(P<0.01),且优化IPoC组优于IPoC组(P<0.05)。结论在STEMI患者PPCI术中,优化缺血后适应术式可以明显减轻再灌注损伤,缩小心肌梗死面积,减少再灌注心律失常,减轻炎症反应,改善心功能及心室重构,起到很好的心脏保护作用。

Objective To observe the effects of optimized post-ischemic conditioning(IPoC)on myocardial ischemia-reperfusion injury on acute STEMI patients during primary percutaneous coronary intervention(PPCI),and explore the best operation mode of optimized post-ischemic conditioning.Methods From June 2018 to March 2020,150 patients with STEMI and PPCI were randomly divided into control group(50 cases),IPoC group(50 cases)and optimized IPoC group(50 cases).The control group received routine PCI treatment;In the IPoC group,after opening the infarct related artery(IRA),conventional ischemic postconditioning was given,and then stents were implanted;The optimized IPoC group was given optimized ischemic postconditioning and stent implantation after IRA.The levels of Serum cTnT,NTproBNP and hs-CRP,the incidence of arrhythmia during reperfusion,the percentage of ST segment depression in ECG 24 hours after operation,LVEF of echocardiography and the incidence of major adverse cardiovascular events were compared among the three groups.Results In terms of the levels of postoperative serum CTnT,NT-ProBNP,Hs-CRP,the incidence of arrhythmia cases during PCI,the proportion of ST-segment decline at 24 hours after PCI,the recovery degree of cardiac function,both the optimized IPoC group and the IPoC group were significantly better than the control group(P<0.01),and the optimized IPoC group was better than the IPoC group(P<0.05).Conclusion In PPCI of STEMI patients,optimizing ischemic postconditioning can significantly reduce reperfusion injury,myocardial infarction size,reperfusion arrhythmia,inflammatory response,improve cardiac function and ventricular remodeling,and play a good role in cardiac protection.