肢体远端缺血预适应对择期经皮冠状动脉介入治疗患者的心肌保护作用

Study of limb remote ischemic pre-adaptation provides cardio protection in patients received noncritical percutaneous coronary intervention

目的探讨肢体远端缺血预适应(RIPC)对择期行经皮冠状动脉介入术(PCI)治疗的急性冠状动脉综合征(ACS)患者的心肌保护作用。方法收集2021年1月至2022年10月在延边大学附属医院心内科就诊并进行择期PCI治疗的ACS患者130例,最终纳入120例,采用数字随机法分为上肢RIPC组(n=30)、下肢RIPC组(n=30)、上下肢联合RIPC组(n=30)和对照组(n=30);上/下肢RIPC组患者在PCI手术前2 h用血压计袖带绑于右上肢或右下肢并充气加压至200 mmHg(1 mmHg=0.133 Kpa),使此上肢或下肢血流受阻,经减压5 min后恢复血流5 min,重复上述操作3次,共计30 min。上下肢联合RIPC组患者在PCI术前2 h用血压计袖带将右上肢和右下肢同时捆绑并充气加压至200 mmHg,余处理同上/下肢RIPC组,无上述过程的对照组直接进行PCI。比较术前及术后24 h四组的心肌肌红蛋白(Myo)、肌钙蛋白(c TnI)、肌酸激酶同工酶(CK-MB)、超敏C反应蛋白(hs-CRP)水平,记录术后住院期间和出院后6个月内的主要不良心血管事件(MACE),通过评估MACE事件的发生率,观察肢体RIPC对PCI术后患者预后的影响。结果四组患者术前Myo、cTnI、CK-MB及hs-CRP的基础水平无统计学差异(P>0.05)。四组患者术后Myo、CK-MB、hs-CRP水平组间无统计学差异(P>0.05)。RIPC组cTnI水平术后较对照组明显降低,且差异有统计学意义(P<0.05)。四组患者术中在冠状动脉病变血管植入支架的平均直径、长度、数量及造影剂用量方面均无统计学差异(P>0.05)。术中上肢RIPC组、下肢RIPC组和上下肢联合RIPC组的患者术中胸痛发生率分别为10%、6.67%、6.67%,相比对照组20%胸痛发生率明显降低,且差异有统计学差异(P<0.05)。四组患者住院期间及随访出院后6个月情况:上肢RIPC组、下肢RIPC组及上下肢联合RIPC组MACE事件发生率分别为7.41%、8%、11.1%;明显低于对照组28.57%,差异具有统计学意义(P<0.05)。结论肢体RIPC对择期行PCI治疗的ACS患者的心肌具有保护作用,减少术中胸痛的发生,降低术后6个月MACE事件发生率。

Objective To investigate the myocardial protective effect of limb remote ischemia preadaptation(RIPC)on acute coronary syndrome(ACS)patients undergoing elective percutaneous coronary intervention(PCI).Methods A total of 130 patients with ACS who underwent elective PCI in Yanbian University Affiliated Hospital cardiology department from January 2021 to October 2022,and 120 patients were finally enrolled.The eligible patients were randomly divided into upper limb RIPC group(n=30),lower limb RIPC group(n=30),combined upper and lower limb RIPC group(n=30)and control group(n=30),In the combined upper and lower limb remote ischemic preconditioning(RIPC)group,patients had their right upper limb and right lower limb simultaneously bound with a blood pressure cuff and inflated to 200 mmHg for 2 hours before percutaneous coronary intervention(PCI).The remaining treatment was the same as that for the upper limb RIPC group and the lower limb RIPC group.The control group,without this process,underwent PCI directly.The levels of myocardial myoglobin(Myo),cardiac troponin I(cTnI),creatine kinase-MB(CK-MB),and high-sensitivity C-reactive protein(hs-CRP)were compared among the four groups before surgery and 24 hours after surgery.Major adverse cardiovascular events(MACE)during the postoperative hospital stay and within 6 months after discharge were recorded.The impact of limb RIPC on the prognosis of patients after PCI was observed by assessing the incidence of MACE events.Results There were no statistically significant differences in the baseline levels of Myo,cTnI,CK-MB,and hs-CRP among the four groups before surgery(P>0.05).There were also no statistically significant differences in the postoperative levels of Myo,CK-MB,and hs-CRP among the four groups(P>0.05).Contrarily,the Postopertive level of cTnI in the RIPC group was significantly lower than that in the control group,There are statistically incidence(P<0.05).Additionally,there were no statistically significant differences among the four groups in terms of the average diameter,length,number of stents implanted in coronary lesion vessels,and the amount of contrast agent used during the surgery(P>0.05).During the surgery,patients in the upper limb RIPC group(10%),lower limb RIPC group(6.67%),and combined upper and lower limb RIPC group(6.67%)had a significantly lower incidence of chest pain compared to the control group(20%),with statistical significance(P<0.05).Regarding the situation during hospitalization and the 6-month follow-up after discharge,the incidence of MACE events in the upper limb RIPC group(7.41%),lower limb RIPC group(8%),and combined upper and lower limb RIPC group(11.1%)was significantly lower than that in the control group(28.57%),with statistical significance(P<0.05).Conclusion Limb RIPC can reduce the occurrence of elective PCI myocardial injury and intraoperative chest pain in ACS patients,and can improve the prognosis of elective PCI patients 6 months after surgery.