缺血后处理改善前壁急性心肌梗死患者再灌注心肌长轴的收缩功能

目的：探讨缺血后处理(ischemic postconditioning，IPTC)是否能改善左心室受损的局部或整体长轴的收缩功能。方法：试验分为PCI组、PCI+IPTC组及对照组。PCI组为前壁急性ST段抬高型心肌梗死患者(ST-segment elevation myocardial infarction，STEMI)患者32例，行首次急诊经皮冠状动脉介入治疗(percutaneous coronary intervention，PCI)术；PCI+IPTC组为前壁急性STEMI患者28例，行急诊PCI联合IPTC术；对照组为30例，行冠状动脉造影术。采集术前，术后0.5 h，1 d，3 d，1周，1个月和6个月二维动态超声心动图。对比研究PCI组、PCI+IPTC组与对照组各时间点局部与整体长轴应变参数。结果：PCI+IPTC组PCI术后1周内左心室梗死节段长轴应变高于PCI组(P<0.05)，左心室整体长轴应变较PCI组有增高趋势，但差异无统计学意义(P>0.05)；PCI+IPTC组术后远期左心室局部及整体长轴应变与PCI组比较，差异均无统计学意义(均P>0.05)。结论：IPTC可改善前壁急性STEMI患者PCI术后早期左心室再灌注心肌的长轴收缩功能。

Ischemic postconditioning improves longitudinal contractile function of the reperfused myocardium in patients with anterior wall acute myocardial infarction

Objective: To investigate whether ischemic postconditioning (IPTC) can promote the recovery ofleft ventricular impaired regional or global longitudinal systolic function.Methods: The trial was divided into a percutaneous coronary intervention (PCI) group, an PCI+IPTC group and a control group. Thirty-two patients with anterior acute anterior wall ST-segment elevation myocardial infarction (STEMI) underwent the first emergency PCI in the PCIgroup, 28 patients with anterior acute STEMI underwent the combination of PCI and IPTC in thePCI+IPTC group, while 30 patients underwent coronary angiography in the control group. Twodimensionaldynamic echocardiography was collected before operation, 0.5 h, 1 day, 3 days, 1 week,1 month and 6 months after operation, respectively. The longitudinal strain parameters at differenttime points were analyzed and compared in the 3 groups.Results: The regional longitudinal strain of infracted segments in the PCI+IPTC group after theoperation within 1 week was higher than that in the PCI group (P<0.05). The left ventricularglobal longitudinal strain in the PCI+IPTC group seemed to be higher than that in PCI groupafter the operation within 1 week, but there was not statistically difference (P>0.05). There wasno significant difference in the long-term regional and global longitudinal strains of left ventriclebetween the PCI+IPTC group and the PCI group (both P>0.05).Conclusion: The IPTC can improve the short-term longitudinal systolic function of the reperfusedmyocardium in patients with acute anterior wall STEMI after PCI.