缺血后适应对急性心肌梗死再灌注心肌的保护作用

目的 探讨缺血后适应对急性心肌梗死(AMI)再灌注心肌的保护作用.方法 选择发病12 h内AMI患者140例,完全随机分为对照组和研究组,各70例.研究组于开通闭塞血管1 min内,实施闭塞1 min-再灌注1 min的方法,重复闭塞-再灌注程序4次后持续灌注,观察2组肌酸激酶(CK)及肌酸激酶同工酶的峰值、心电图ST段变化、心肌梗死溶栓试验(TIMI)血流分级、心肌充血分级,并行心脏彩色多普勒超声测定左心室功能.结果 治疗后,研究组CK峰值明显低于对照组,组间差异有统计学意义[(1634±522) U/L比(2476±619) U/L,P＜0.05]；TIMI血流分级≤2级者所占比例明显低于对照组[5.7％ (4/70)比20.0％ (14/70),P＜0.05]；心肌灌注Blush分级≤2级的构成比明显低于对照组(11.4％比22.9％,P＜0.05)；1个月和6个月研究组左心室射血分数较对照组明显改善,组间差异有统计学意义[1个月:(54.0±14.0)％比(50.0±9.0)％,6个月:(56.0±12.0)％比(52.0±11.0)％,均P ＜0.05)].结论 缺血后适应可改善梗死相关血管的血流灌注,同时也可以改善心肌组织水平灌注,减少无再流发生,减轻心肌损伤.缺血后适应操作简单,具有临床应用前景.

Protective effect of ischemic postconditioning on myocardial ischemia-reperfusion injury during primary coronary angioplasty

Objective To explore if postconditioning may protect the human heart during coronary angioplasty treating acute myocardial infarction. Methods A total of 140 patients undergoing coronary angioplasty for a cute myocardial infarction were randomly assigned into postconditionong group and control group. The patients in posteonditioning group were performed within 1 minute of reflow by 4 episodes of 1 -minute inflation and l-minute deflation of the angioplasty balloon. The creatine kinase peaks were measured and thormbolysis in myocardial infarction （TIMI） flow and blush grade were analyzed for all patients after the procedure. Ejection fraction was measured in one and six months after the procedure by echocardiography. Results The creatine kinase peak was significantly lower than tha in control group [ （ 1634 ± 522） U/L vs （ 2476 ± 619 ） U/L, P 〈 0.05 ]. TIMI flow and blush grade were significantly higher than those in control group [ 5.7 % （4/70） vs 20.0% （ 14/70）, P 〈 0. 05 ]. In 1 and 6 months ejection fraction was improved greatly in the postconditioning group compared with control group[ （54.0 ± 14.0）% vs （50.0±9.0）%, （56.0±12.0）% vs （52.0＋11.0）%, P〈0.05）]. Conclusion Postcondition- ing improves the infarcted related artery flow and blood flow in the cardiac tissue, reduces infarct size reduction and improves functional recovery.