急性心肌梗死缺血后处理对患者发生心肌梗死后心力衰竭的影响

目的探讨缺血后处理对急性心肌梗死后患者心力衰竭的影响。 方法选取2014年1月至2015年12月于吉林大学附属吉林医院心血管诊治中心第二疗区住院患者200例，起病时间在12 h内，并急诊行经皮冠状动脉介入(PCI)治疗的患者，根据随机数字表法随机分为两组，对照组(100例，常规PCI治疗)和缺血后处理组(IPTC组)(100例，给予缺血后处理)。比较两组患者的血清同工酶(CK-MB)、肌钙蛋白I(cTnI)、脑钠肽(BNP)水平和心脏彩超中的左室射血分数(LVEF)和左室舒张末内径(LVEDD)值。 结果心肌梗死后3 d时，对照组cTnI为(40.40±3.85)ng/ml，IPTC组为(23.12±2.36)ng/ml，两组间比较差异有统计学意义(t＝7.30，P<0.05)，对照组显著高于IPTC组。心肌梗死后14 d时，对照组BNP为(2 595±239)pg/mL，IPTC组为(1 391±154)pg/mL，两组间比较差异有统计学意义(t＝6.54，P<0.05)，对照组显著高于IPTC组。在随访3个月时，对照组LVEF值为(48.16±4.62)mm，IPTC组LVEF值为(57.11±4.43)mm，两组间比较差异有统计学意义(t＝21.50，P<0.05)，对照组显著低于IPTC组。在6个月时随访复查LVEF值，对照组为(49.78±6.22)mm，IPTC组为(60.41±3.94)mm，两组间比较差异有统计学意义(t＝4.67，P<0.05)，对照组显著低于IPTC组。在6个月时随访复查LVEDD值，对照组为(52.19±6.42)mm，IPTC组为(44.24±5.47)mm，两组间比较差异有统计学意义(t＝7.70，P<0.05)，对照组显著高于IPTC组。 结论缺血后处理可以改善急性心肌梗死后患者的心功能，减少急性期心肌梗死损伤。

Effect of ischemic postconditioning on heart failure after myocardial infarction in patients with acute myocardial infarction

ObjectiveTo explore the ischemic postconditioning effects on heart failure after acute myocardial infarction. MethodsThere were 200 myocardial infarction patients within 12 h on emergency PCI, of which 100 patients received routine PCI therapy (control group), and the other 100 patients received ischemic postconditioning therapy(IPTC group). The parameters between the two groups of CK-MB, cTnI, BNP, and the LVEF, LVEDD by echocardiography were observed. Results3 days after myocardial infarction the cTnI level of control group (40.40±3.85)ng/ml was higher than that of IPTC group (23.12±2.36)ng/ml, the difference was statistically significant (t＝7.30，P<0.05). 14 days after myocardial infarction the BNP level of control group (2 595±239)pg/ml was higher than that of IPTC group (1 391±154)pg/ml, the difference was statistically significant (t＝6.54，P<0.05). 3 months after myocardial infarction the LVEF data of normal control group (48.16±4.62)mm was lower than that of IPTC group (57.11±4.43)mm, the difference was statistically significant (t＝21.50，P<0.05). 6 months after myocardial infarction the LVEF data of normal control group (49.78±6.22)mm was lower than that of IPTC group (60.41±3.94)mm, the difference was statistically significant (t＝4.67，P<0.05). 6 months after myocardial infarction the LVEDD data of control group (52.19±6.42)mm was higher than that of IPTC group (44.24±5.47)mm, the difference was statistically significant (t＝7.70，P<0.05). ConclusionIschemic postconditioning could improve cardiac function after myocardial infarction, and reduce the acute myocardial infarction injury.