王贵松,赵威,郭丽君,张福春,高炜

• 1:北京大学第三医院心内科
• 2:北京大学第三医院心内科

摘要(Abstract)：

目的探讨直接经皮冠状动脉介入术(PCI)中球囊充盈次数与心肌灌注和心肌坏死程度的关系,评价缺血后适应在直接PCI中可能的临床效果。方法回顾分析2004年1月至2006年12月于我院行直接PCI的ST段抬高性心肌梗死(STEMI)患者140例,梗死相关血管(IRA)为左前降支(LAD)或右冠状动脉(RCA),术前IRA血流为TIMI0级,且无侧支循环充盈,术后TIMI血流达3级。排除心搏骤停复苏后、心源性休克、曾患心肌梗死或有梗死前心绞痛的患者。按直接PCI中球囊充盈次数将患者分为A组(球囊充盈次数为1～2次者)和B组(球囊充盈次数为3次或以上者),其中A组62例,B组78例。直接PCI后心肌灌注情况用心肌Blush分级和ST段恢复情况来评价,心肌坏死程度用心肌酶[肌酸激酶(CK),肌酸激酶同工酶(CK-MB)]释放峰值水平和出院前超声心动图测得左室射血分数(LVEF)来评价。结果两组患者基本临床特征相似,PCI中球囊充盈次数B组显著高于A组(4.7±0.9比1.8±0.2,P<0.05)。PCI术后造影示心肌Blush分级B组(2.35±0.32)明显高于A组(1.89±0.29),P<0.05。两组患者入院时心电图最大ST段抬高幅度相似,分别为4.53±0.62mm(A组)和4.31±0.58mm(B组)(P>0.05),术后2h最大ST段抬高幅度分别降至1.65±0.49mm和0.98±0.37mm(P<0.05)。B组患者CK及CK-MB峰值水平均显著低于A组(1368±726U/L比1976±869U/L,P<0.05;132±76U/L比189±84U/L,P<0.05)。出院前B组LVEF(54.76%±11.24%)明显高于A组(47.68%±10.17%,P<0.05)。结论直接PCI术中需多次球囊充盈的患者较最少球囊充盈次数的患者心肌灌注改善、心肌坏死程度减轻,提示多次球囊充盈以断续的方式来解除持续性心肌缺血可能模拟了缺血后适应的心脏保护作用。

关键词(KeyWords)： 心肌梗死;血管成形术,经腔,经皮冠状动脉;心肌再灌注;缺血后适应

Abstract:

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基金项目(Foundation):

作者(Author): 王贵松,赵威,郭丽君,张福春,高炜

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