经皮腔内冠状动脉成形术中缺血预适应现象及其对血浆内皮素水平的影响Ischemic preconditioning in percutaneous transluminal coronary angioplasty and its influences to plasma endothelin
郑玉云,洪涛,朱国英,霍勇,邢德智,刘梅林,唐朝枢,邵耕,石湘芸,赵云涛
摘要(Abstract)：
为研究经皮腔内冠脉成形术（PTCA）中的缺血预适应（IP）现象及其对血浆内皮素（ET）水平的影响，对33例成功的进行了PTCA的患者进行分组研究。其中10例采用缺血预适应方法，即球囊首次扩张90秒至2分钟，继以3～5分钟再灌注（A组），其余23例为非缺血预适应组（B组）。观察所有患者术中心绞痛症状及体表心电图ST段变化，并分别于术前、术后即刻、15分钟、1、3和24小时从股动脉取血，放免法测定ET水平。结果示：A组第二次扩张时心绞痛症状及ST段偏移程度均较第一次扩张时显著减轻（P＜0．05）；B组两次扩张时心绞痛症状及ST段偏移程度均无明显改变。A组术后血浆ET呈升高趋势，但与术前比较无统计学意义（P＞0．05）；B组血浆ET水平术后即刻升高，3小时达高峰，峰值较术前增高113．9％（P＜0．01），术后24小时恢复术前水平。提示IP不仅使心肌缺血程度减轻，同时可减轻PTCA对血浆ET水平的影响。
关键词(KeyWords)： 缺血预适应;冠状动脉成形术.经皮.经腔;内皮素
基金项目(Foundation): 卫生部基金
作者(Author): 郑玉云,洪涛,朱国英,霍勇,邢德智,刘梅林,唐朝枢,邵耕,石湘芸,赵云涛
参考文献(References)：
- 1 Crivber A, Korsatz L, Koning R,et al. Improved myocardial ischemic response and enhanced collateral circulation with long repetitive coronary occlusion during angioplasty: a prospective study. JACC. 1992,20:578-586.
- 2Deutsch E,Berger M,Kussmaul WG,et al.Adaptation to ischemia during percutaneous transluminal coronary angioplasty. Cir ,1990,82 : 2044-2051.
- 3 Lawson CS, Dewney JM. Preconditioning: State of the art myocardial protection.Cardiovase Res,1993,27:542-550.
- 4 Oldroyd KG,Paterson JR,Rumley AG,et al.Coronary venous lipid peroxide concentrations after coronary angioplasty: correlation with biochemical and electrocardiographic evidence of myocardial ischemia.Br Heart J,1992,68:43-47.
- 5 Chester AH,Dashwood MR,Clarke JG,et al.Influence of endothelin on human coronary arteries and localization of its binding sites. Am J Cardiol, 1989,63:1395-1398.
- 6 Malatino L S , Grassi R, Stancanelli B, et al.Release immunore-active endothelin from the heart during percutaneous transluminal coronary angioplasty.Am Heart J,1993,126:700- 702.
- 7汤健,唐朝枢,杨军,等.内皮素.第一版.北京:北京医科大学中国协和医科大学联合出版社,1994年.
- 8Spielberg C,Schwenn K, Hensen J, et al. Endothelin levels in the coronary sinus during PTCA of the left descending coronary artery . Cir ,1991,84: Ⅱ-726.
- 9Trachtenberg JD,Sun S,Choi ET,et al.Effect of ET-1 infusion on the development of intimal hyperplasia after balloon catheter injury. J Cardiovasc Pharmacol,1993,22: S 355-359.