摘要
目的观察心内缺血预处理对冠状动脉血流动力学的快速影响，探讨其临床意义。方法选择经冠状动脉造影证实1或2支冠状动脉狭窄70％-85％的冠心病患者17例，随机分为心内缺血预处理组（8例）和非缺血预处理组（9例）。介入治疗前，心内缺血预处理组实施2周期心内缺血预处理，分别监测两组患者靶血管狭窄近端和远端的非闭塞压、闭塞压。结果缺血预处理组缺血预处理前靶血管闭塞压由（22．08±19．14）mmHg升高至处理后（25．46±19．04）mmHg（P=0．011），血流储备分数由（70．30±16．05）％升高至（77．53±13．42）％（P=0．001），差异均有统计学意义，侧支血流显著改善。结论冠状动脉内缺血预处理可以提高冠状动脉严重病变的冠状动脉楔压及血流储备分数，改善侧支血流。
Objective To observe the immediate hemodynamic effects of the intercoronary ischemic preconditioning on the coronary perfusion pressure. Methods The observational study recruited 17 patients who were hospitalized for stable coronary disease and had severe stenosis lesions （70% ± 85% ） in one or two vessels per coronary angiography. They were randomized into ICPC（ n = 8）group （receiving two cycles of l-rain balloon inflation and 5-min reperfusion） and control group （n =9）. Before interventional treatment,the ICPC group was given 2 cycles of intercornary ischemic preconditioning. The occlusive and non-occlusive pressures proximal and distal to the stenosis were collected before and after ICPC. Fractional flow reserve （FFR） was calculated upon the following equation ： FFR = Pd/Pa （ Pa： hyperemic mean aortic pressure, Pd： hyperemic coronary pressure distal to the stenosis）. Results Before and after ischemic preconditioning, coronary wedge pressure and FFR of ICPC group were significantly increased （ coronary wedge pressure was from [ 22.08 ± 19. 14 ] mm Hg to [25.46±19.04]mmHg,P=O. 011;FFRwasfrom [70.30±16.051% to [77.53 ±13.421% ,P=0. O01）. The collateral flow was increased significantly. Coronary wedge pressure and FFR of control group did not improved obviously. There were significant differences in FFRs and coronary wedge pressures between ICPC and control groups. Conclusion Coronary ischemic preconditioning can improve coronary perfusion pressure, and rapidly increase the coronary pressure distal to the severe stenosis lesions.
出处
《中国综合临床》
2012年第4期360-364,共5页
Clinical Medicine of China
基金
杭州市科技发展计划项目（20110733Q09）
关键词
冠心病
冠状动脉内缺血预处理
冠状动脉楔压
血流储备分数
侧支循环
Coronary heart disease
Intercomnary ischemic preconditioning
Coronary wedgepressure
Fractional flow reserve
Collateral circulation
