缺血预适应改善急性心肌梗死经皮冠状动脉介入治疗的预后Ischemic preconditioning improves the prognosis for acute myocardial infarction patients with percutaneous coronary intervention
程中伟,吕卫华,程康安,谢洪智,刘震宇,曾勇,范中杰,沈珠军,张抒扬,方全
摘要(Abstract):
目的研究梗死前心绞痛对接受PCI治疗急性心梗患者临床预后的影响。方法回顾分析122例首次发生的急性心肌梗死患者。所有患者在发病12h内进行PCI,按梗死前48h有无心绞痛分为2组,即缺血预适应组(56例)和非缺血预适应组(66例)。比较两组患者梗死相关血管PCI后血流TIMI分级、再灌注心律失常情况、心肌酶峰值浓度及出院前心脏事件发生率。结果缺血预适应组患者年龄高于非缺血预适应组(66±12比61±12,P=0.05)。非ST段抬高心肌梗死患者数量缺血预适应组明显多于非缺血预适应组,分别为30.4%和12.1%(P=0.01)。PCI后梗死相关血管无复流发生率在缺血预适应组明显低于非缺血预适应组,分别为4%和15%(P=0.03)。缺血预适应组心肌损伤标志物峰值浓度较非缺血预适应组显著降低,重度左室功能不全(LVEF<40%)发生率在缺血预适应组明显低于非缺血预适应组,分别为4%和15%(P=0.03)。结论缺血预适应组急性心梗患者PCI术后心肌酶峰值明显降低,以及梗死相关血管无复流发生率和重度左室功能不全患者比例明显降低,表明缺血预适应对急性心梗患者心脏具有保护作用,改善预后。
关键词(KeyWords): 心肌梗死;经皮冠状动脉介入术;缺血预处理
基金项目(Foundation):
作者(Author): 程中伟,吕卫华,程康安,谢洪智,刘震宇,曾勇,范中杰,沈珠军,张抒扬,方全
参考文献(References):
- [1]Murry CE,Jennings RB,Reimer RA,et al.Preconditioning with ischemia:A delay of lethal cell injury in ischemic myocardium.Circulation,1986,74:1124-1136.
- [2]Cohen MV,Liu GS,Downey JM.Preconditioning causes improved wall motion as well as infarcts after transient coronary occlusion in rabbits.Circulation,1991,84:341-349.
- [3]Cave Ac,Collis CS,Dowmey JM,et al.Improved functional recovery by ischemic preconditioning is not mediated by adenosine in the globally ischemic isolated rat heart.Cardiovasc Res,1993,27:663-668.
- [4]陈灏珠,主编.实用内科学下册.11版.北京:人民卫生出版社,2000:1373-1381.
- [5]Ito H,Maruyama A,Iwkura K,et al.Clinical implications of the'no-reflow'phenomenon:a predictor of complications and left ventricular remodeling in perfused anterior wall myocardial infarction.Circulation,1996,93:223-228.
- [6]Rezkalla SH,Klonre RA.No-reflow phenomenon.Circulation,2002,105:656-662.
- [7]Reffelmann T,Kloner RA.The"No-reflow"phenomenon:basic science and clinical correlates.Heart,2002,55:466-473.
- [8]赵京林,杨跃进,尤士杰,等.缺血预适应对猪急性心肌梗死再灌注无复流的影响.中国医学科学院学报,2005,27(4):486-490.
- [9]Reffelmann T,Kloner RA.Is microvascular protection by cariporide and ischemic preconditioning causally linked to myocardial salvage?Am J physiol Heart cire physiol,2003,284:1134-1141.
- [10]吴伟力,傅向华,马宁,等.缺血预适应及侧支循环对缺血再灌注心肌的保护作用.中华心血管病杂志,2004,32:717-722.
- [11]张敬,付研,李田昌,等.缺血预适应在急性心肌梗死溶栓和PTCA中心肌保护作用的研究.中华急诊学杂志,2002,11:392-403.
- [12]胡允兆,卢剑华,吴炎贤,等.急性心肌梗死中缺血预适应可否保护心肌.岭南心血管病杂志,2006,12:276-279.