缺血后处理对急性心肌梗死患者血清氧自由基的影响及意义

目的探讨缺血后处理对急性心肌梗死患者血清超氧化物歧化酶(SOD)、丙二醛(MDA)影响及临床意义。方法根据急诊经皮介入治疗术(PCI)是否设置心肌梗死后处理方式，将101 例急性ST段抬高型心肌梗死患者分为缺血后处理组(46 例)和常规PCI组(55 例)，比较两组术后4 h、8 h、12 h、16 h、20 h、24 h、36 h 和48 h 血清SOD及MDA动态变化，比较两组PCI后心肌梗死溶栓(TIMI)血流、TIMI 心肌灌注分级(TMPG)、血清肌酸激酶同工酶MB(CK-MB)酶峰，术后10 d 核素心肌显像计分以及30 d 内心脏事件的发生率。结果与常规PCI 组比较，术后缺血后处理组血清SOD值明显升高(P<0.01)，MDA值明显降低(P<0.001)；SOD谷值明显增高(P<0.01)，MDA峰值显著降低(P<0.001)；TIMI 血流3 级和TMPG 3 级患者均增多(P<0.05)；血清CK-MB峰值明显降低(P<0.01)；心肌显像计分降低(P<0.05)。术后30 d 内缺血后处理组心脏事件发生率低于常规PCI 组(P<0.05)。结论急性ST段抬高型心肌梗死救治中，缺血后处理能升高PCI 术后血清SOD浓度，减少MDA产生，改善心肌灌注，减小梗死面积，改善患者预后。

Effect of Ischemic Postconditioning on Serum Superoxide Dismutase and Malondialdehyde in Acute Myocardial Infarction

Objective To explore the effect of ischemic postconditioning on serum superoxide dismutase (SOD) and malondialdehyde (MDA) in acute myocardial infarction (AMI) and clinical significance. Methods 101 AMI patients accepted emergency percutaneous coronary intervention (PCI) were divided into postconditioning group (n=46) and control group (n=55) according to the treatment they accepted.The concentration of serum SOD and MDA were observed 4, 8, 12, 16, 20, 24, 36, and 48 h after PCI, as well as the grade of Thrombolysisin Myocardial Infarction (TIMI) and TIMI Myocardial Perfusion Grades (TMPG), serum creatine kinase-MB (CK-MB) peak value, scoring of nuclide distribution 10 d after PCI, and frequence of cardiac events within 30 d after PCI. Results Compared with the control group, serum SOD increased (P<0.01) and MDA decreased (P<0.001) respectively 2, 4, 8, 12, 16, 20, 24, 36 and 48 h after the PCI, especially the valley of SOD and peak of MDA value in the postconditioning group; while the patient with TIMI flow of grade 3 and TMPG of grade 3 increased (P<0.05), the peak of serum CK-MB decreased (P<0.01), and the score of nuclide distribution decreased (P<0.05). After the operation for 30 days, the frequence of cardiac events was less in the postconditioning group than in the control group (P<0.05). Conclusion Ischemic postconditioning can reduce the peroxidation after PCI, to increase myocardial perfusion, reduce infarct area, and improve prognosis in acute ST-segment elevated myocardial infarction