远隔器官后适应联合依达拉奉对急性心肌梗死患者心肌缺血再灌注损伤作用的研究

Efficacy of remote ischemic postconditioning combined with Edaravone for patients with myocardial ischemia-reperfusion after acute myocardial infarction

目的:探讨远隔器官后适应联合应用依达拉奉对急性心肌梗死患者心肌缺血再灌注损伤的作用。方法:选取2013年01月至2014年12月我院收治的急性心肌梗死患者144例,随机分为I/R组(静脉溶栓治疗)、RPOC组(静脉溶栓治疗+远隔器官后适应治疗)、E组(静脉溶栓+依达拉奉注射液静脉点滴)、ER组(静脉溶栓+远隔器官后适应+依达拉奉注射液静脉点滴),每组36例,分析各组患者肌酸激酶同工酶(creatine kinase isoenzymes,CKm B)及肌钙蛋白(cardiac troponinⅠ,c Tn I)分泌峰值及其动态变化,同时比较各组患者溶栓治疗后超声心动图指标,治疗后进行随访,观察不良事件发生情况。结果:CKm B、c Tn I峰值在I/R组、E组、RPOC组、ER组患者中依次降低,组间差异均具有统计学意义(P<0.05);与I/R组比较,E组、EROC组、ER组患者左室舒张末内径(left ventricular enddiastolic,LVED)、计算室壁节段运动指数(wall motion score index,WMSI)均明显降低,左室射血分数(left ventricular ejection fractions,LVEF)%明显升高(P<0.05);ER组患者LVED、WMSI均明显低于E组和RPOC组(P<0.05),LVEF%明显高于E组和RPOC组(P<0.05),WMSI明显低于E组(P<0.05),但与RPOC组比较差异无统计学意义(P>0.05);4组患者治疗后均随访3个月,随访期间均无失访和死亡病例,E组、EROC组、ER组再梗死、脑卒中、梗死后心绞痛、心力衰竭等不良事件发生率均明显低于I/R组(P<0.05),但3组间比较,差异无统计学意义(P>0.05)。结论:远隔器官后适应及依达拉奉的应用都能显著减少CKm B和c Tn I的释放,减轻急性心肌梗死后心室重塑,改善室壁运动,从而减轻心肌再灌注的损伤,改善预后。

Objective:To investigate the efficacy of remote ischemic postconditioning with Edaravone for patients with myocardial ischemia-reperfusion after acute myocardial infarction. Methods:Totally 144 cases of patients with acute myocardial infarction were selected and randomly divided into four groups,including I/R group(intravenous thrombolysis),RPOC group(intravenous thrombolysis+remote ischemic postconditioning),E group(intravenous thrombolysis +Edaravone injection),ER group(intravenous thrombolysis +remote ischemic postconditioning+Edaravone injection),each having 36 cases. The peak value and dynamic changes of CKm B and c Tn I were analyzed and the echocardiographic indexes were compared;the adverse clinical events were observed. Results:There were significant differences between the four groups in the peak value of CKm B,c Tn I and LVED,LVEF%,WMSI(P<0.05). During followup period,the occurring rate of adverse clinical events of E,EROC,ER group were significantly lower than that of I/R group(P<0.05).Conclusion:The application of remote ischemic postconditioning and Edaravone can significantly reduce CKm B and,c Tn I release,reduce the ventricular remodeling,and improve the ventricular wall motion,thereby reducing myocardial reperfusion injury.