摘要
目的探讨缺血后适应的心肌保护作用。方法41例首次发生急性心肌梗死的患者随机分入对照组(n=18)和缺血后适应组(n=23)。各例接受急诊PTCA治疗。对照组梗死血管再通后3min内不施加干预;缺血后适应组梗死血管再通后1min内应用低气压充盈和回撤球囊,每一过程各30s。术后观察梗死血管TIMI血流、心肌Blush分级、72h内肌酸磷酸激酶(CK)、术后2hST段回落,出院前左心室射血分数等指标,与对照组进行比较。结果术后2hST段回落、梗死血管TIMI血流、心肌Blush分级两组差异无统计学意义。缺血后适应组72h内CK平均值连线的曲线下面积显著减低(58002比79787,P=0.04)。结论急诊PTCA缺血后适应过程能够通过减少心肌梗死面积减轻再灌注损伤,提供心肌保护作用。
Objective To explore the hypothesis that postconditioning during percutaneous transluminal coronary angioplasty （PTCA） would improve cardiac function and reduce infarct size after prolonged reperfusion. Methods Forty-one patients undergoing primary PTCA with acute myocardial infarction were randomized into the control group （ n = 16） or the postconditioning （ n = 23） group within 90 minutes after admission. In the control group, no intervention was given at the onset of reperfusion, while in the postconditioning group, three cycles of repetitive angioplasty balloon inflation and deflation was performed within 1 minute after reperfusion. ST segment regression, TIMI flow and blush grade were analyzed for all patients after the procedure. Ejection fraction and infarct size assessed by nuclear imaging were quantified respectively at 7 days after restoration of reperfusion. Results S＇r segment resolution, TIMI flow and blush grade between the two groups were compatible. Area under the curve of serum CK release during the first 72 hours of reperfusion was significantly reduced in the postconditioning group than that in the control group （58002 vs 79787, P = 0.04）. There was a tendency towards amefioration in ejection fraction in the postconditioning compared with the control group （52.1% ± 12.9% vs 44.5%± 16.7%, P = 0.29） . Conclusion Pusteonditioning during PICA protects the heart against acute myocardial ischemic-reperfusion injury. More importantly, the study indicates that protection with postconditioning is still preserved after an extended reperfusion, suggesting a permanent protection.
出处
《中国介入心脏病学杂志》
2006年第6期323-326,共4页
Chinese Journal of Interventional Cardiology
关键词
心肌梗死
心肌再灌注损伤
后适应
Myocardial infarction
Myocardial reperfusion injury
Postconditioning
