缺血后适应对急性ST段抬高心肌梗死患者急诊介入治疗近期效果的影响

Influence of ischemic postconditioning on the short-term outcome of emergency interventional therapy for ST elevation myocardial infarction

目的探讨心肌缺血后适应(IPoC)对急性ST段抬高心肌梗死患者急诊介入治疗近期效果的影响。方法抽取2021年3月至2022年3月在濮阳市安阳地区医院行急诊经皮冠状动脉介入术(PCI)治疗的急性ST段抬高心肌梗死患者80例,按入院时间顺序随机编码排序分为对照组(奇数)和IPoC组(偶数),每组40例。对照组行常规PCI治疗,IPoC组在开通梗死相关血管后,先给予IPoC处理,再置入支架。比较两组术中再灌注心律失常及无/慢血流的发生率,比较两组术前及术后24 h的血清炎性指标及心肌损伤指标[C反应蛋白(CRP)、红细胞沉降率(ESR)、心肌肌钙蛋白I(cTn-I)、肌酸激酶同工酶(CK-MB)、脑钠肽(BNP)]、室性心律失常预测指标[QT间期、T波峰末(Tpeak-Tend)间期及Tpeak-Tend/QT比值],比较两组术后24 h及术后1周的心脏彩超指标[左心室舒张末期内径(LVEDD)和左室射血分数(LVEF)],比较两组术后1周内心脏不良事件发生率。结果IPoC组术中再灌注心律失常及无/慢血流的发生率[40.0%(16/40),15.0%(6/40)]均低于对照组[75.0%(30/40),37.5%(15/40)],差异有统计学意义(P<0.05)。术后24 h,两组CRP及ESR水平均较术前有下降趋势,且IPoC组CRP、ESR水平低于对照组(P<0.05);术后24 h,两组cTn-I、CK-MB、BNP水平均较术前明显升高,但IPoC组cTn-I、CK-MB、BNP水平均低于对照组(P均<0.05);IPoC组QT间期大于对照组,Tpeak-Tend间期及Tpeak-Tend/QT小于对照组(P<0.05)。术后1周,IPoC组LVEDD小于对照组,LVEF大于对照组(P<0.05)。术后1周,IPoC组心脏不良事件发生率(5.00%,2/40)低于对照组(20.00%,8/40),P<0.05。结论在急性ST段抬高心肌梗死患者急诊PCI术中,IPoC术式可以明显减少再灌注心律失常、无/慢血流的发生,减轻炎症反应,减小梗死面积,减轻心肌损伤,降低恶性心律失常的发生率,改善心室早期重构及心功能,降低近期心脏不良事件发生率。

Objective To investigate the effect of myocardial ischemic postconditioning(IPoC)on the short-term outcome of emergency interventional therapy for ST elevation myocardial infarction.Methods A total of 80 patients with acute ST elevation myocardial infarction who underwent emergency percutaneous coronary intervention(PCI)treatment in Anyang District Hospital of Puyang from March 2021 to March 2022 were selected,and they were divided into control group(odd number)and IPoC group(even number)by randomly coded according to the chonological order of admission,with 40 cases in each group.The control group was treated by conventional PCI;while the IPoC group was treated by IPoC after opening the infarct-related vessels,and then,the stent was implanted.The incidence of reperfusion arrhythmia and no/slow blood flow in the two groups were compared,the serum inflammatory indexes,including C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR),myocardial injury indexes,including cardiac troponin(cTn-I),creatine kinase isoenzyme MB(CK-MB)and brain natriuretic peptide(BNP),and ventricular arrhythmia prediction indexes,including QT interval,Tpeak-end interval and Tpeak-Tend/QT of the two groups were compared before and 24 hours after operation.The cardiac color Doppler indexes,including left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF),of the two groups were compared at 24 hours and 1 week after operation.The incidence of adverse cardiac events within 1 week after operation of the two groups were compared.Results The incidence of reperfusion arrhythmia and no/slow blood flow in the IPoC group(40.0%,16/40;15.0%,6/40)were lower than those in the control group(75.0%,30/40;37.5%,15/40),P<0.05.At 24 hours after operation,the levels of CRP and ESR in both groups showed a downward trend,compared with those before operation,and the levels of CRP and ESR in the IPoC group were lower than those in the control group(P<0.05);the levels of cTn-I,CK-MB and BNP in the two groups were significantly higher than those before operation,however,the levels of cTn-I,CK-MB and BNP in the IPoC group were lower than those in the control group(P<0.05);the QT interval of IPoC group was larger than that of the control group,and the Tpeak-End interval and Tpeak-End/QT were smaller than those of the control group(P<0.05).One week after operation,LVEDD in the IPoC group was lower than that in the control group,and LVEF was higher than that in the control group(P<0.05).One week after operation,the incidence of adverse cardiac events in the IPoC group(5.00%,2/40)was lower than that in the control group(20.00%,8/40),P<0.05.Conclusions In the emergency PCI for ST elevation myocardial infarction,IPoC can significantly reduce the occurrence of reperfusion arrhythmia,no/slow blood flow,reduce inflammatory reaction,reduce infarction size,reduce myocardial injury,reduce the occurrence of malignant arrhythmia,improve early ventricular remodeling and cardiac function,and reduce the incidence of short-term adverse cardiac events.