摘要
目的探讨渐进式缺血后适应(GIP)再灌注方式在急诊经皮冠状动脉介入治疗(PCI)对急性ST段抬高型心肌梗死(STEMI)患者心功能和预后的影响。方法纳入105例急性STEMI患者,根据不同急诊PCI手术方式随机分为3组,常规PCI组、缺血后适应(IP)组和GIP组,每组35例。观察并比较3组患者术中再灌注心律失常发生率、肌钙蛋白I(cTnI)峰值、肌酸激酶同工酶(CK-MB)峰值、ST段回落(STR)、术后校正心肌梗死溶栓试验(TIMI)血流帧数(CTFC)和住院期间主要不良心血管事件(MACE)的发生情况,并随访患者术后1年状况。结果3组患者再灌注心律失常发生率比较差异均有统计学意义(P<0.05)。3组患者CK-MB峰值、cTnI峰值、术后CTFC、住院期间MACE发生率比较,差异均有统计学意义(P<0.05)。GIP组STR率M50%的患者比例明显高于其他两组,差异有统计学意义(P<0.05)。术后随访1年,3组患者LVEF、出现心绞痛、非致死性心律失常、非致死性心力衰竭患者的比例比较差异均有统计学意义(P<0.05),而再发性心肌梗死患者的比例比较差异无统计学意义(P>0.05),与其他两组相比,GIP组LEVF、出现心绞痛、非致死性心力衰竭患者的比例比较差异有统计学意义(P<0.05),结论急性心肌梗死(AMI)患者行急诊PCI时IP能够降低心肌再灌注损伤、减少再灌注心律失常的发生率,改善心功能及预后,GIP则更有优势。
Objective To explore the effect of gradual ischemic postconditioning( GIP) reperfusion for primary emergency percutaneous coronary intervention ( PCI) on cardiac function and prognosis of patients with acute ST-segment elevation myocardial infarction ( STEMI). Methods 105 patients with acute STEMI were randomly assigned to the control PCI group, the ischemic postconditioning(IP) group and the gradual IP ( GIP) group according to the different emergency PCI. The peak of cardial tropnin I( cTnI), creatine kinase isoenzyme-MB ( CK-MB ), ST segment resolution ( STR ), the corrected thrombolysis in myocardial infarction (TIMI) frame count ( CTFC ), in-hospital major adverse cardiovascular events( MACE) were observed and analyzed among three groups. Follow-up one year,postoperative effect and prognosis were compared. Results Incidence of reperfusion arrhythmia, the peak of cTnI, CK-MB, postoperation CTFC and in-hospital MACE were significant among three groups ( P <0. 05). The rate of patients with STR≥50% were significantly higher in GIP group than other two groups ( P <0. 05). After 1 year, left ventricular ejection fraction ( LVEF), angina, non-fatal heart failure, non-fatal arrhythmia were significantly different among three groups, but recurrence of myocardial infarction had no significant difference,while compared with other groups,GIP group in LVEF was higher and the rate of angina,non-fatal heart failurewerelower. Conclusion IP within primary PCI can reduce the incidence of myocardial ischemia-reperfusion injury and the rate of reperfusion arrhythmia, improve cardiac infunction, GIP group had better results.
作者
陆丽媛
操传斌
王能
Lu Liyuan;Cao Chuanbin;Wang Neng(Department of Cardiology, Suizhou Hospital of Hubei University of Medicine, Suizhou 441300, China)
出处
《临床内科杂志》
CAS
2019年第6期390-393,共4页
Journal of Clinical Internal Medicine
关键词
缺血后适应
急性心肌梗死
经皮冠状动脉介入治疗
再灌注损伤
Ischemic postconditioning
Acute myocardial infarction
Percutaneous coronary intervention
Reperfusion injury
