再灌注预处理对急性心肌梗死患者的影响

目的探讨急诊经皮冠状动脉介入术(percutaneous coronary intervention,PCI)治疗时再灌注预处理对急性心肌梗死患者的影响。方法 87例急性心肌梗死患者行急诊PCI时,45例于支架植入前行低流量灌注10min(预处理组),42例直接行球囊扩张和支架植入(对照组)。观察2组支架植入后罪犯血管无复流发生率、再灌注心律失常、心肌损伤标志物水平和心功能变化。结果预处理组支架植入后罪犯血管无复流发生率(6.7%)低于对照组(16.7%)(P<0.01),术中及术后2h内再灌注心律失常发生率(24.4%)低于对照组(40.1%)(P<0.01),血清肌酸激酶同工酶峰值(52.5±19.4)μg/L低于对照组(66.8±22.9)μg/L(P<0.05),术后第7天左心室射血分数(55±12)%高于对照组(48±13)%(P<0.05)。结论急性心肌梗死患者行急诊PCI时采用低流量灌注进行再灌注预处理可减少心肌再灌注损伤,提高治疗效果。

Effect of reperfusion preconditioning on acute myocardial infarction

Objective To evaluate the effect of reperfusion preconditioning on the patients with acute myocardial infarction(AMI) during primary percutaneous coronary intervention(PCI).Methods A total of 87 patients with AMI receiving primary PCI were divided into preconditioning group(n=45) receiving preconditioning with low-flow perfusion for 10 minutes before stent implantation,and control group(n=42) directly receiving balloon dilatation and stent implantation without preconditioning.The incidences of no-reflow,reperfusion arrhythmias,myocardial injury marker levels and cardiac function were recorded after stent implantation.Results The incidence of no-reflow was significantly lower in preconditioning group(6.7%) than that in control group(16.7%)(P<0.01).The incidence of reperfusion arrhythmias was significantly lower in preconditioning group(24.4%) than that in control group(40.1%) during PCI and 2 hours after PCI(P<0.01).The creatine kinase-myocardial band peak was(52.5±19.4) μg/L in preconditioning group significantly lower than that in control group(66.8±22.9) μg/L(P<0.05).The left ventricular ejection fraction was significantly higher in preconditioning group(0.55±0.12) than that in control group(0.48±0.13) 7 days after PCI(P<0.05).Conclusion During primary PCI,reperfusion preconditioning with low-flow perfusion can reduce myocardial reperfusion injury,and enhance the therapeutic effect.