摘要
目的 探讨综合远程缺血适应对老年急性ST段抬高型心肌梗死(STEMI)患者急诊PCI的心脏保护作用。方法 选取2016年9月~2019年12月首都医科大学宣武医院心内科行急诊PCI的老年STEMI患者328例,采用随机数字表法分入实验组165例(急诊PCI联合综合远程缺血适应)和对照组163例(单纯急诊PCI)。心脏MRI分析急诊PCI术后5~7 d心肌可挽救指数。心脏超声分析急诊PCI术后24 h、6个月及1年时左心室舒张末期容积指数、左心室收缩末期容积指数及LVEF。记录急诊PCI术后肌钙蛋白I峰值、1个月及1年的堪萨斯城生存质量表临床评分(KCCQ-CSS)、6 min步行试验(6MWD)及1年时主要不良心血管事件(MACE)。结果 实验组急诊PCI术后5~7 d心肌可挽救指数较对照组明显升高[0.6(0.4,0.7)vs 0.5(0.4,0.6),P=0.037]。实验组急诊PCI术后1个月及1年6MWD明显高于对照组[335(258,360)m vs 303(250,345)m,P<0.01;425(360,445)m vs 403(345,432)m,P<0.05]。实验组急诊PCI术后1个月及1年KCCQ-CSS明显高于对照组[81(47,87)分vs 70(39,82)分,P<0.01;86(55,93)分vs 76(46,89)分,P<0.01]。Pearson相关性分析显示,心肌可挽救指数与术后1年LVEF、KCCQ-CSS、6MWD呈正相关(r=0.452,P<0.01;r=0.440,P<0.01;r=0.384,P<0.01)。Kaplan-Meier生存曲线分析显示,2组1年时MACE比较,差异无统计学意义(χ~2=0.165,P=0.685)。结论 综合远程缺血适应可显著提高老年STEMI患者行急诊PCI的心肌可挽救指数、生活质量和运动能力,且易于操作、耐受性好,可以作为老年STEMI患者的辅助治疗措施。
Objective To determine the protective effect of comprehensive remote ischemic conditioning(CRIC) on the elderly patients with acute STEMI undergoing primary PCI.Methods A total of 328 elderly STEMI patients undergoing primary PCI in the department of cardiology of Xuanwu Hospital from September 2016 to December 2019 were prespectively recruited in this study.They were randomly divided into treatment group(n=165,primary PCI combined with CRIC) and control group(n=163,simple primary PCI).Cardiovascular magnetic resonance(CMR) imaging was performed to calculate myocardial salvage index(MSI) in 5-7 d after primary PCI.ECG was carried out to measure LVEF,LVEDVI,and LVESVI at 24 h, 6 months and 1 year after primary PCI.The peak level of cTnI after PCI,KCCQ-CSS and 6 MWD in 1 month and 1 year and major adverse cardiovascular events(MACE) in 1 year after primary PCI were recorded.Results MSI was significantly higher in the treatment group at 5-7 d after primary PCI than the control group [0.6(0.4,0.7) vs 0.5(0.4,0.6),P=0.037].The treatment group achieved longer 6 MWD at 1 month [335(258,360)m vs 303(250,345)m, P<0.01] and 1 year [425(360,445)m vs 403(345,432)m, P<0.05],and higher KCCQ-CSS scroes in 1 month [81(47,87) vs 70(39,82),P<0.01] and 1 year [86(55,93) vs 76(46,89),P<0.01] when compared with the control group.Pearson correlation analysis showed that MSI was positively correlated with LVEF, KCCQ-CSS score and 6 MWD in 1 year after primary PCI,respectively(r=0.452,P<0.01;r=0.440,P<0.01;r=0.384,P<0.01).Kaplan-Meier survival curve analysis indicated that no statistical difference in occurrence of MACE between the 2 groups in 1 year after surgery(χ~2=0.165,P=0.685).Conclusion CRIC can significantly improve MSI,quality of life and exercise capacity in elderly STEMI patients undergoing primary PCI.It is easy to operate and well tolerated, and can be used as an auxiliary treatment for the patients.
作者
王艳玲
杨旗
胡程艳
褚研研
孙峥
赵欢
刘志
Wang Yanling;Yang Qi;Hu Chengyan;Chu Yanyan;Sun Zheng;Zhao Huan;Liu Zhi(Department of Cardiology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2022年第10期1031-1035,共5页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
国家自然科学基金(62172288)。
关键词
ST段抬高型心肌梗死
急诊处理
磁共振成像
经皮冠状动脉介入治疗
心室重构
心力衰竭
ST elevation myocardial infarction
emergency treatment
magnetic resonance imaging
percutaneous coronary intervention
ventricular remodeling
heart failure
