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急性ST段抬高型心肌梗死患者缺血后处理对心肌梗死面积的影响 被引量:11

Infraction size in patients with acute ST-elevation myocardial infraction after ischemia post-conditioning
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摘要 目的:评估缺血后处理(IPost)对直接经皮冠状动脉介入治疗术(PCI)治疗的急性ST段抬高型心肌梗死(STEMI)患者梗死面积的影响。方法:将于我院接受治疗的268例急性STEMI患者根据是否接受IPost随机分为IPost组和对照组。IPost组患者完全复灌前给予1min再闭塞/1min再灌注反复4次完成IPost处理,之后行支架置入术。对照组再灌注后直接行支架置入术。结果:对照组和IPost组4个月后梗死面积分别为14.3%和13.2%(P=0.17)。影响梗死面积的独立风险因素包括症状发作-球囊扩张时间和前壁梗死。PCI术后心肌灌注分级、再灌注60min后ST回落幅度、肌钙蛋白T峰值或4个月后左心室射血分数(LVEF)值未见组间差异(均P>0.05)。在两次接受心脏磁共振(CMR)的患者中,IPost对患者心肌挽救指数和LVEF均无显著影响(P>0.05)。结论:未发现IPost对梗死面积或次要研究结局存在显著影响。 Objective:To evaluate the effect of ischemia post-conditioning(IPost)on infraction size in acute ST-elevation myocardial infraction(STEMI)patients underwent percutaneous coronary intervention(PCI).Method:A total of 268 patients with STEMI treated in our hospital were randomly divided into IPost group and control group according to whether underwent the ischemia post-conditioning or not.Post-conditioning in patients of IPost group were finished by four episodes of 1-min reocclusion and 1-min reperfusion,followed by stent implantation.Patients in control group were given stent implantation after reperfusion.Result:Infraction size in control group and IPost group after 4 months was 14.3%and 13.2%(P=0.17)respectively.The independent risk factors that impact the infraction size include symptom-balloon time and anterior myocardial infarction.Myocardial perfusion grade after PCI,ST resolution 60 minutes after reperfusion,troponin T or value of left ventricular ejection fraction(LVEF)after 4 months showed no significant difference between two groups(all P〉0.05).For the patients underwent two CMR examinations,IPost didn't show significant effect on myocardial salvage index and LVEF(both P〉0.05).Conclusion:IPost has no significant effect on infraction size and concerned secondary outcomes.
作者 闫卫军 李小静 YAN Weijun;LI Xiaojing(Emergency Department,Yan'an People's Hospital,Yanan,Shaanxi,716000,China)
出处 《临床心血管病杂志》 CAS CSCD 北大核心 2018年第11期1095-1099,共5页 Journal of Clinical Cardiology
关键词 梗死面积 急性ST段抬高型心肌梗死 缺血后处理 经皮冠状动脉介入治疗 infraction size acute ST-elevation myocardial infraction ischemia post-conditioning percutaneous coronary intervention
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