远端缺血预处理对经皮冠状动脉介入治疗相关心肌损伤及预后的影响

目的探讨远端缺血预处理对经皮冠状动脉介入治疗(PCI)术后心肌损伤及预后的影响。方法本研究为一项单中心前瞻、随机、对照研究,采用随机数字表法将92例拟行择期PCI术的不稳定性心绞痛患者分为远端缺血预处理组和对照组。最终纳入65例成功完成PCI术的不稳定性心绞痛患者,远端缺血预处理组36例,对照组29例。远端缺血预处理组在行PCI治疗前1 h用血压袖带200 mmHg压力给予患者4个5 min缺血/5 min再灌的循环处理,对照组不作处理,两组患者均在PCI术当天凌晨6点及术后20 h测血清CK-MB、cTnI及hs-CRP水平的含量,并记录术后3个月再发心绞痛、心肌梗死、死亡等主要不良心血管事件(MACE)的情况。结果 2组患者的主要基线指标无统计学差异。远端缺血预处理组患者术后CK-MB、cTnI、hs-CRP水平较对照组降低,有统计学差异(P<0.05),2组患者术后3个月MACE发生率无统计学差异。结论远端缺血预处理可降低PCI相关心肌损伤并改善预后。

Effects of remote ischemic preconditioning on myocardial injury and prognosis after percutaneous coronary intervention

Objective To explore the effects of remote ischemic preconditioning on myocardial injury and prognosis after percutaneous coronary intervention （PCI）.Methods A total of 92 patients with unstable angina undergoing elective PCI were randomly assigned to remote ischemic preconditioning group （induced by four 5-minute inflations of a blood pressure cuff to 200 mmHg around the upper arm, followed by 5-minute intervals of reperfusion at 1 h before PCI therapy） or control （an uninflated cuff around the arm）. Successful completion of the PCI eventually included 65 cases of patients, including 36 cases in the remote ischemic preconditioning group and 29 cases in the control group. CK-MB and cTnI and hs-CRP levels were measured at 6 o＇clock in the morning of the day and at 20 hours after PCI between the two groups. Both groups of patients recorded the postoperative 3 months major adverse cardiac events （MACE, including recurrence of angina pectoris, myocardial infarction and death）.Results CK-MB and cTnI and hs-CRP levels in patients with distal ischemia preconditioning group were significantly lower than those form the control group after PCI （P〈0.05）, but there was no significant statistical differences between incidence of MACE （P〉0.05）.Conclusion The remote ischemia preconditioning can be related to reduce myocardial injury of PCI and to improve prognosis.