无创性肢体缺血预适应对后继急性心肌梗死影响的临床研究

目的观察无创性肢体缺血预适应（noninvasive delayed limb ischemic preconditioning,NDLIP）对后继急性心肌梗死（acutemyocardial infarction,AMI）的影响。方法首先在老年人群中宣传肢体缺血预适应的益处,动员每人用弹性绷带绑紧大腿根部,造成下肢短时间缺血,3次/d,5min/次,间隔10min,建立健康档案,长期跟踪观察。发现有胸闷、心前区不适、心前区疼痛症状者,立即住院行心电图、心肌酶谱检查,确诊为AMI后,随机归为NDLIP组,共20例。并随机选取20例未用此方法的AMI病人作为对照组。2组均于入院后给予同样的尿激酶治疗,并比较治疗后血管再通率以及并发症发生率。结果 NDLIP组和对照组血管再通率分别为80%、70%,差异有统计学意义（P〈0.05）;4周病死率分别为0、5%,差异有统计学意义（P〈0.05）。结论应用NDLIP的AMI病人与未用此方法的AMI病人相比,血管再通率明显提高,病死率显著减少,预后更好。NDLIP对AMI病人具有很好的心肌保护作用。NDLIP有望为AMI的防治提供可行、简便、有效的方法。

Clinical research of the influence of noninvasive delayed limb ischemic preconditioning on subsequent acute myocardial infarction

Objectives To observe the curative effect of NDLIP on the patients with subsequent AMI.Methods 40 cases of patients after AMI were selected for this study,the patients were divided into two groups:NDLIP group,control group.Patients in NDLIP group were preconditioned before AMI by occluding the lower limb arteries for 5 minutes 3 times at an interval of 10 minutes.In control group there was not NDLIP.All patients were provided with urokinase treatment.The contrast was made about the vessel repatency rate and mortality in four weeks among all patients.Results The vessel repatency rate was 80% in NDLIP group,and 70% in control group respectively.The vessel repatency rate was significantly increased in NDLIP group compared with that in control group,and the difference was of statistic significance(P<0.05).The mortality in four weeks was 0 in NDLIP group,5% in control group respectively,and the difference was of statistic significance(P<0.05).Conclusion NDLIP can increase the vessel repatency rate and reduce the mortality,there was a better curative effect than with sheer urokinase treatment.The discovery of the great cardioprotective potential of NDLIP has opened a feasible,simple and effective route for treating AMI.