周鹏,刘臣,李健楠,周金英,陈润真,赵宵潇,王莹,赵汉军,宋莉,颜红兵

• 1:国家心血管病中心北京协和医学院中国医学科学院阜外医院冠心病中心
• 2:中国医学科学院阜外医院深圳医院冠心病中心

摘要(Abstract)：

目的 探索急性前壁心肌梗死患者应用全程远隔缺血适应治疗后（缺血间期及缺血后28 d）对心功能及临床预后的影响。方法 本研究采用单中心、前瞻性、非盲、随机、对照入组，从2017年4月至2019年9月连续入选中国医学科学院阜外医院因急性前壁ST段抬高型心肌梗死行直接经皮冠状动脉介入治疗的患者共163例，按照1:1比例随机分入对照组和全程远隔缺血适应组，全程远隔缺血适应组患者从血管再灌注前（缺血间适应）、血管再灌注后即刻（缺血后适应）直至介入治疗术后第28天（延迟缺血后适应）通过袖带加压充放气的方式完成全程远隔缺血适应治疗。所有患者临床随访12个月。共有126例患者术后30 d时完成心脏磁共振成像。结果 对照组的心肌肌钙蛋白I峰值高于全程远隔缺血适应组[30.672(14.472,57.111)ng/ml比22.771(7.908,40.027)ng/ml,P=0.008]；而30d时超声心动图测得的左心室射血分数低于全程远隔缺血适应组[（56.3±7.7）%比（59.1±7.5）%,P=0.027]。全程远隔缺血适应组与对照组相比，没有增加30 d时心脏磁共振成像测得的左心室射血分数[（49.8±10.0）%比（48.4±10.2）%,P=0.419]；两组延迟强化的体积分数差异无统计学意义[11.5(2.9,17.3)%比10.8(5.8,19.8)%,P=0.585]；两组随访12个月时的主要不良心脑血管事件发生率差异无统计学意义（8.5%比2.5%,P=0.096）。结论 全程远隔缺血适应组并没有增加急性前壁心肌梗死患者30 d时心脏磁共振成像测得的左心室射血分数，没有改善12个月时的临床事件发生率。

关键词(KeyWords)： 远隔缺血适应;急性前壁心肌梗死;经皮冠状动脉介入治疗;心脏磁共振成像

Abstract:

Keywords:

基金项目(Foundation): 中国医学科学院医学与健康科技创新工程基金（2016-I2M-1-009、NCT 03593928）;; 三名工程（深圳市第5批引进高层次医学团队）中国医学科学院阜外医院颜红兵急性冠状动脉综合征诊治团队

作者(Author): 周鹏,刘臣,李健楠,周金英,陈润真,赵宵潇,王莹,赵汉军,宋莉,颜红兵

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