缺血后适应对老年冠心病患者缺血再灌注肢体血管内皮功能的影响

目的 观察缺血再灌注不同时刻给予缺血后适应,对老年冠心病患者血管内皮功能的保护作用.方法 选取老年冠心病患者54例,随机分为3组,缺血再灌注组、后适应组及延迟后适应组.建立肢体缺血再灌注模型,在再灌注不同时刻(1 min内及1 min后)分别给予后适应组及延迟后适应组缺血后适应干预,通过超声检测肱动脉血流介导的舒张功能(FMD),观察缺血再灌注前后反应性充血血管内径的变化.结果 缺血再灌注组再灌注后FMD明显减小(P＜0.05),再灌注1 min内给予缺血后适应有明显的血管内皮功能保护作用,与缺血再灌注组比较,后适应组FMD明显提高(6.70±2.36 vs 3.05±0.91,P＜0.05),而延迟后适应组则失去了内皮功能保护作用(3.17±1.04 vs 3.05±0.91,P＞0.05).结论 再灌注1 min内给予缺血后适应可以改善血管内皮功能,但延迟后适应的保护作用消失.

Effect of ischemia preconditioning and postconditioning on emergency percutaneous coronary intervention in elderly patients with acute myocardial infarction

Objective To explore the effect of ischemia preconditioning (IPC) and postconditioning on emergency percutaneous coronary intervention (PCI) in elderly patients with acute myocardial infarction (AMI). Methods 106 elderly patients with AMI who received PCI within 12 h were selected. 35 patients with preinfarction angina and postconditioning were selected as IPC+postconditioning group. 37 patients with postconditioning during intervention were selected as postconditioning group. The other 34 patients without IPC nor postconditioning were ischemia/reperfusion (IR) group. Corrected TIMI frame count (CTFC), serum creatine phosphokinase (CK), CK-MB, malondialdehyde (MDA) were measured before and after PCI. Wall motion score index (WMSI) was assessed by two-dimentional echocardiography before and 8 weeks after angioplasty. Results Patients of IPC+ postconditioning group and postconditioning group had much faster CTFC than those of IR group (27.12±5.84, 26.98±5.76 vs 31.53±7.41, P＜0.05). The peaks of CK and CK-MB of IPC+ postconditioning group and postconditioning group were much lower than those of IR group (1 243.35±801.31, 1 238.67±817.26 vs 1 697.76±965.63 U/L, P＜0.05; 120.97±78.28, 117.94±75.81 vs 174.45±92.67 U/L, P＜0.05), there was no difference between IPC+ postconditioning group and postconditioning group. MDA in three groups was significantly higher than that of control group on admission, and was lower than that of the IR group on any time of post-operation. After 8 weeks of operation, the WMSI of IPC+ postconditioning group and postconditioning group were much lower than that of IR group (1.16±0.12, 1.17±0.11 vs 1.31±0.15, P＜0.05). Conclusions Postconditioning is the same as preconditioning in improving coronary artery flow velocity, reducing oxygen free radical, improving heart function. Superposition of postconditioning preconditioning has no increasing effect on above function.