缺血预适应与缺血后适应现象对急性心肌梗死急症介入治疗后的影响

目的研究梗死前心绞痛（缺血预适应）与缺血后适应对急性心肌梗死患者介入治疗后冠状动脉血流速度及预后的影响。方法选取12h内接受急症冠状动脉介入治疗的心肌梗死患者96例,分为3组,有梗死前心绞痛症状者为预适应组（35例）,接受缺血后适应干预者为后适应组（32例）、单纯再灌注组29例,测定校正心肌梗死溶栓帧数（CTFC）、血肌酸磷酸激酶（CK）、肌酸磷酸激酶同工酶（CK—MB）、丙二醛,术后8周测定室壁运动记分。结果缺血预适应组与后适应组的CTFC（27±6,27±6）明显快于单纯再灌注组（31±7,均P〈0．05）,CK峰值与CK—MB峰值明显低于单纯再灌注组（1242U／L±801U／L,1237U／L±813U／LV81697U／L±966U／L,均P〈0．05）;122U／L±78U／L,117U／L±76U／LV8172U／L±93U／L,P〈0．05）;各组患者入院时丙二醛均高于对照组,术后各时点缺血预适应组与后适应组均低于单纯再灌注组。术后8周缺血预适应组与后适应组室壁运动恢复优于单纯再灌注组（1．2±0．2,1．2±0．2V81．4±0．3,P〈0．05）。结论缺血后适应与预适应一样可以改善介入治疗后冠状动脉血流速度,减少自由基的生成,改善心功能。

Effects of preconditioning and postconditioning on emergency percutaneous coronary intervention in patients with acute myocardial infarction

OBJECTIVE: Postconditioning is a novel approach to myocardial protection during ischemia reperfusion. To investigate the effects of preconditioning and postconditioning on coronary blood flow velocity and prognosis of the patients with acute myocardial infarction (AMI) undergoing emergency percutaneous coronary intervention (PCI). METHODS: Ninety-six patients with AMI underwent revascularization by primary PCI within 12 h after the onset. The 35 patients with preinfarction angina were treated with preconditioning (Precond group). The other 61 patients without preinfarction angina were randomized into two groups: 29 patients undergoing PCI without postconditioning [reinfusion (IR) group], and 32 patients undergoing PCI with postconditioning (3 cycles of reinfusion for 30 s/re-occlusion for 30 s beginning within 1 minute after reinfusion, Postcond group). Corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) was used to evaluate the velocity of coronary blood after PCI. Creatine phosphokinase (CK), CK-MB, and malondialdehyde (MDA) were measured before and after PCI. Wall motion score index (WMSI) was assessed by two-dimensional echocardiography before and 8 weeks after angioplasty. RESULTS: There were no significant differences between the three groups with regard to age, sex, presence of angiographically visible collaterals, and elapsed time from the onset of symptoms until perfusion. The CTFC values of the patients of the Precond and Postcond groups were both 27 +/- 6, 27 +/- 6, both significantly faster than that of the patients of the IR group (31 +/- 7, both P < 0.05). The CK peak values of the Precond and Postcond groups were 1242 U/L +/- 801 U/L and 1237 U/L +/- 813 U/L respectively, both significantly lower than that of the IR group (1697 U/L +/- 966 U/L, P < 0.05). The CK-MB peak values of the Precond and Postcond groups were 122 U/L +/- 78 U/L and 117 U/L +/- 76 U/L respectively, both significantly lower than that of the IR group (172 U/L +/- 93 U/L, P < 0.05). The MDA of the Precond and Postcond groups at all time points were all significantly lower than that of the IR group (all P < 0.05). The WMSI values 8 weeks after PIC of the Precond and Postcond groups were 1.2 +/- 0.2, and 1.2 +/- 0.2 respectively, both significantly lower than that of the IR group (1.4 +/- 0.3, P < 0.05). CONCLUSION: A simple and operative procedure to improve the coronary blood flow velocity and heart function and reduce the production of free oxygen radicals, postconditioning can be used clinically widely so as to better the prognosis of AMI.