2015-3缺血后适应对急性心肌梗死急诊介入治疗心肌灌注及预后的影响详解.doc

缺血后适应对急性心肌梗死急诊介入治疗心肌灌注及 预后的影响 黄文军，闫博宇，李莺 基金项目：江西省卫生厅科技项目（江西省萍乡市人民医院心血管内科，江西萍乡 337055） [摘要]目的:探讨缺血后适应对急性心肌梗死(AMI)急诊经皮冠状动脉介入治疗（PCI）患者心肌灌注和预后的影响。方法: 203例AMI行急诊PCI 治疗的患者, 随机分为缺血后适应组103例和对照组100例，缺血后适应组在再灌注开始1 min内行缺血后适应处理，对照组患者在再灌注后最初6 min内不作干预。观察两组患者cTnI峰值、CK-MB峰值，左心室射血分数(LVEF)、室壁运动评分指数(WMSI)，校正的TIMI 帧计数(CTFC)、及住院期间主要心血管不良事件(MACE)有无差异。结果: 1、两组患者在年龄、性别、危险因素、梗死相关血管、缺血时间等方面均无显著差异，P0.05）； 2、缺血后适应组的CTFC明显快于对照组(25.3±7.9 vs 29.4±8.4，p0.05)； 3、CK-MB峰值与cTnI峰值明显低于对照组(157.3±83.6 vs 201.5±77.3；2.5±1.3 vs 3.1±1.0，P0.05)；4、两组患者入院时LVEF及WMSI均无差异，术后6个月IPOC组LVEF及WMSI均明显优于对照组(57.4±8.7 vs 53.6±9.3；1.19±0.4 vs1.27±0.3，P0.05)。5、IPOC组术后6个月MACE发生率明显低于对照组 (P0.05)。结论：缺血后适应能够改善AMI 急诊PCI 患者冠状动脉血流、减轻心肌细胞缺血-再灌注损伤，改善心功能及预后。 [关键词]急性心肌梗死；经皮冠状动脉介入；缺血后适应；主要心血管事件 Effects of Ischemic Postconditioning on Myocardial Perfusion and Prognosis in Patients Treated with Emergency Percutaneous Coronary Intervention for Acute Myocardial Infarction HUANG Wen-jun，YAN Bo-yu，Li Ying （Vasculocardiology Deparment, the People’s Hospital of Pingxiang City, Pingxiang 337055, China） [Abstract]Objective: To investigate the effects of ischemic postconditioning（IPOC） on myocardial perfusion and prognosis in patients treated with emergency percutaneous coronary intervention（PCI） for acute myocardial infarction. Methods 81 patients diagnosed with AMI who needed elective emergency PCI were randomly assigned to 2 groups: IPOC group with 103 patients , control group with 100 patients. In the control group, no additional intervention was performed during the first 6 min of reperfusion. In the ischemic postconditioned group, within 1 min of reflow, the angioplasty balloon was reinflated three times for 1 min using low-pressure (4-6 atm) inflations, each separated by 1 min of reflow. Cardiac troponin I (cTnI) peaks, creatine kinase-MB(CK-MB) peaks, corrected thrombolysis in myocardial infarction(TIMI) frame count (CTFC) ,wall motion score index (WMSI) , left ventricular ejection fraction ( LVEF) and major adverse cardia