摘要
目的:探讨缺血后适应(PC)对ST段抬高型心肌梗死(STEMI)患者心肌微循环保护的临床效果。方法:选取2023年1月—2024年3月在新余市人民医院确诊的90例STEMI患者,采用随机数字表法将患者分为观察组(n=45)和对照组(n=45)。观察组采用PC技术开通梗死相关动脉(IRA),对照组采用常规手术策略开通IRA。比较两组IRA无复流发生率、心肌梗死溶栓治疗(TIMI)3级达标率,治疗前和治疗后7 d炎症因子和氧化应激指标,围手术期并发症发生率及出院后6个月内主要不良心脑血管事件(MACCE)发生情况。结果:观察组IRA无复流发生率和TIMI 3级达标率分别为8.89%和91.11%,和对照组的24.44%、75.56%比较,差异有统计学意义(P<0.05)。治疗后7 d,两组CRP、TNF-α、IL-1β水平均较治疗前降低,且观察组降低程度较对照组更为显著(P<0.05)。治疗后7 d,两组丙二醛(MDA)水平较治疗前降低,超氧化物歧化酶(SOD)水平较治疗前升高,且观察组改善程度较对照组明显(P<0.05)。观察组围手术期并发症发生率为4.44%,与对照组的6.67%比较,差异无统计学意义(P>0.05)。观察组MACCE发生率为8.89%,与对照组的13.33%比较,差异无统计学意义(P>0.05)。结论:PC能够有效降低STEMI患者的IRA无复流发生率,改善心肌微循环,减轻炎症和氧化应激反应。
Objective:To explore clinical effect of postconditioning(PC)in the protection of myocardial microcirculation in patients with ST-segment elevation myocardial infarction(STEMI).Method:A total of 90 patients diagnosed STEMI in Xinyu People's Hospital from January 2023 to March 2024 were selected and divided into observation group(n=45)and control group(n=45)by random number table method.The observation group used PC technology to open infarct-related artery(IRA),while the control group used conventional surgical strategy to open IRA.The incidence of IRA non-reflow and compliance rate of thrombolysis in myocardial infarction(TIMI)grade 3,inflammatory factors and oxidative stress indexes before treatment and 7 days after treatment,the incidence of perioperative complications and the occurrence of major adverse cardiovascular and cerebrovascular events(MACCE)within 6 months after discharge were compared between the two groups.Result:The incidence of IRA non-reflow and compliance rate of TIMI grade 3 in the observation group were 8.89%and 91.11%,respectively,which were statistically different from 24.44%and 75.56%in the control group(P<0.05).Seven days after treatment,the levels of CRP,TNF-αand IL-1βwere decreased in both groups compared with those before treatment,and the degree of decrease in the observation group were more significant than those in the control group(P<0.05).Seven days after treatment,the levels of malondialdehyde(MDA)were decreased,the levels of superoxide dismutase(SOD)were increased in both groups compared with those before treatment,and the improvement degree in the observation group were more significant than those in the control group(P<0.05).The incidence of perioperative complications in the observation group was 4.44%,which was not different from 6.67%in the control group(P>0.05).The incidence of MACCE in the observation group was 8.89%,which was not different from 13.33%in the control group(P>0.05).Conclusion:PC can effectively reduce the incidence of IRA non-reflow,improve myocardial microcirculation,and alleviate inflammatory and oxidative stress response in STEMI patients.
作者
曾庆宏
夏金兰
胡小武
ZENG Qinghong;XIA Jinlan;HU Xiaowu(Department of Cardiovascular Medicine,Xinyu People's Hospital,Xinyu 338000,China;不详)
出处
《中国医学创新》
2025年第23期41-45,共5页
Medical Innovation of China
基金
新余市科技计划项目(20233090802)。
关键词
缺血后适应
ST段抬高型心肌梗死
心肌微循环
Postconditioning
ST-segment elevation myocardial infarction
Myocardial microcirculation
