摘要
目的:探讨超声指导下围手术期生理性缺血训练(PIT)对急性心肌梗死患者心肌缺血再灌注损伤的影响。方法:纳入急性心肌梗死患者62例,随机分为对照组、传统PIT治疗组(Tra-PIT组)和超声指导下PIT治疗组(Ult-PIT组)。对照组接受经皮冠状动脉介入治疗(PCI)和常规药物治疗,Tra-PIT组、Ult-PIT组在对照组基础上接受围手术期PIT治疗。Tra-PIT组和Ult-PIT组患者采用的PIT加压方案压力分别为收缩压以上20mmHg和超声测量的肱动脉完全闭塞压力(TOP)。三组患者在PCI术后测定血清心肌肌钙蛋白T(cTnT)浓度测算心肌梗死面积,术后第3日评估6min步行距离(6MWD)、完善心脏超声测量左心室射血分数(LVEF)、评估心肌梗死多维度评估量表(MIDAS)。同时对肱动脉TOP的相关影响因素进行分析。结果:围手术期cTnT评估的心肌梗死面积Ult-PIT组显著低于对照组(P<0.05)。Ult-PIT组患者的术后6MWD显著高于Tra-PIT组和对照组(P<0.05)。术后LVEF与MIDAS分值三组比较无显著性差异(P>0.05)。线性回归分析显示收缩压、舒张压与臂围是TOP的相关影响因素。结论:超声指导下围手术期PIT训练可降低围手术期cTnT评估的心肌梗死面积,使急性心肌梗死患者在围手术期获益。
Objective:To explore effects of perioperative ultrasound-guided physiological ischemic training(PIT)protocol on myocardial ischemia reperfusion injury in patients with acute myocardial infarction(AMI).Method:Sixty-two AMI patients were randomized to control group,traditional PIT group(Tra-PIT group)and ultrasound-guided PIT group(Ult-PIT group).All three groups received percutaneous coronary intervention(PCI)and routine drug therapy.Patients in the Tra-PIT group and Ult-PIT group received perioperative PIT training protocol,and the pressure applied during PIT cuff inflation was 20 mmHg above systolic blood pressure or brachial artery total occlusion pressure(TOP)determined with ultrasound measurement.The concentration of cardiac troponin T(cTnT)were measured after PCI to assess myocardial infarction area.On the third day after PCI,the three groups were assessed by 6-minute walking distance(6MWD),left ventricular ejection fraction(LVEF),and the myocardial infarction dimensional assessment scale(MIDAS).And the related influencing factors of TOP were analyzed.Result:The perioperative cTnT assessed myocardial infarction area in the Ult-PIT group was significantly lower than that in the control group(P<0.05).Postoperative 6MWD in Ult-PIT group was significantly higher than that in the Tra-PIT group and control group(P<0.05).There was no statistical difference in postoperative LVEF or MIDAS scores among three groups(P>0.05).Linear regression analysis showed systolic blood pressure,diastolic blood pressure and arm circumference were the predictive variables of TOP.Conclusion:Perioperative ultrasound-guided PIT provides benefit to the myocardium of AMI patients by reducing cTnT evaluated myocardial infarction size.
作者
余秋雨
郑瑜
陆晓
YU Qiuyu;ZHENG Yu;LU Xiao(The First Affiliated Hospital of Nanjing Medical University,Nanjing,210029)
出处
《中国康复医学杂志》
CAS
CSCD
北大核心
2023年第10期1358-1365,共8页
Chinese Journal of Rehabilitation Medicine
基金
国家自然科学基金面上项目(82072546)。
关键词
生理性缺血训练
急性心肌梗死
超声
经皮冠状动脉介入治疗
围手术期
physiological ischemic training
acute myocardial infarction
ultrasound
percutaneous coronary intervention
perioperative period
