心肌缺血后适应循环时间对急诊经皮冠状动脉介入治疗患者的影响

doi:10.6040/j.issn.1671-7554.0.2015.586

摘要/Abstract

摘要： 目的探讨不同缺血后适应循环时间对急诊经皮冠脉介入治疗(PCI)患者的临床及预后影响。方法 100例急性ST段抬高性前壁心肌梗死患者随机分为4组:常规PCI组(n=25)接受常规PCI;IPOC-1组(n=25)于前降支开通1 min后即开始实施反复低压(4~6 atm)充盈和回缩球囊3次,30 s/次;IPOC-2组(n=25)于前降支开通1 min后即开始实施反复低压(4~6 atm)充盈和回缩球囊3次,第1次30 s,第2次60 s,第3次90 s;IPOC-3组(n=25)于前降支开通1 min后即开始实施反复低压(4~6 atm)充盈和回撤球囊3次,60 s/次。术后4、8、12、16、20、24、48、72 h检测肌酸磷酸激酶同工酶(CK-MB),术后72 h检测心肌肌钙蛋白I(cTNI),术前及术后24 h检测血清超敏C反应蛋白(hs-CRP),术后计算校正TIMI帧数(CTFC),术后7 d及3个月行超声心动图及单电子发射电子计算机扫描(SPECT)检查。结果与常规PCI组相比,IPOC-1组、IPOC-2组、IPOC-3组血清CK-MB峰值、72 h cTNI浓度均明显降低(P<0.05)。与IPOC-1组和IPOC-3组相比,IPOC-2组血清CK-MB峰值、72 h cTNI浓度均明显降低(P<0.05)。4组术前hs-CRP浓度差异无统计学意义(P>0.05),术后24 h血清hs-CRP浓度,IPOC-2组最低(P<0.05)。与常规PCI组、IPOC-1组、IPOC-3组相比,IPOC-2组CTFC明显减低(P<0.05)。术后7 d,各组LVEDD、Ea/Aa、LVEF差异无统计学意义(P>0.05),IPOC-2组SPECT评分为4组最低值(P<0.05)。术后3个月,4组LVEDD差异无统计学意义(P>0.05),与常规PCI组、IPOC-1组、IPOC-3组相比,IPOC-2组LVEF、Ea/Aa明显升高(P<0.05)。SPECT评分显示,IPOC-2组最低(P<0.05)。各组术后3个月SPECT评分与术后7 d相比明显降低(P<0.05)。结论心肌缺血后适应有利于减少心肌梗死面积、降低心肌再灌注损伤、改善心脏收缩及舒张功能。

关键词: 循环时间, 急诊经皮冠脉介入治疗, ST段抬高性心肌梗死, 缺血后适应

Abstract: Objective To investigate the impact of different cycle times of myocardial ischemic postconditioning on the clinical outcome and prognosis of patients undergoing primary percutaneous coronary intervention(PCI). Methods A total of 100 patients with acute ST-elevation anterior infarction were randomly assigned to 4 groups. The routine group(n=25)received conventional PCI. The first postconditioning group(IPOC-1 group, n=25)underwent 3 cycles of repetitive balloon deflation and inflation with low pressure(4-6 atm)1 minute after opening the anterior descending, and every cycle lasted for 30 seconds. The second postconditioning group(IPOC-2 group, n=25)received the same operation; however, the first cycle lasted for 30 seconds, the second 60 seconds, and the third 90 seconds. The last 山东大学学报 (医学版)54卷2期 -胡浩然,等.心肌缺血后适应循环时间对急诊经皮冠状动脉介入治疗患者的影响 \=-postconditioning group(IPOC-3 group, n=25)underwent within 1 minute reflow by 3 cycles of 1-minute inflation and 1-minute deflation of the angioplasty balloon. Blood sampling for the creatine kinase isoenzyme MB(CK-MB), cardiac troponin I(cTNI)and high sensitive C-reactive protein(hs-CRP)were taken at predetermined time after PCI. Corrected Timi Frame Count(CTFC)was calculated by two senior interventional experts. All patients received Doppler ultrasound examination and rest ^99mTc- sestamibi(^99mTc-MIBI)myocardial perfusion single photon emission computed tomography(SPECT)7 days and 3 months after PCI. Results The peak(CK-MB)and cTNI concentration 72 hours after PCI of the IPOC-2 group were lower than those of the routine group, IPOC-1 group and IPOC-3 group(all P<0.05). No differences were observed in the hs-CRP concentration before PCI among the 4 groups, but the hs-CRP concentration 24 hours after PCI was lower in the IPOC-2 group compared with the other groups(all P<0.05). CTFC of the IPOC-2 group significantly reduced compared with other groups(all P<0.05). On day 7 after PCI, the LVEDD, Ea/Aa and LVEF of all 4 groups had no significant differences(all P>0.05), but the SPECT score of the IPOC-2 group was the lowest(P<0.05). After 3 months, no statistical differences were found in the LVEDD of the 4 groups; nevertheless, the LVEF, Ea/Aa and SPECT score of the IPOC-2 group tended to have the best outcome(all P<0.05). The SPECT score was significantly lowered in each group 3 months after PCI in comparison with the corresponding group 7 days after operation(all P<0.05). Conclusion The myocardial ischemic postconditioning can dramatically decrease myocardial infarction size, attenuate myocardial ischemic reperfusion injury and improve cardiac function.

Key words: Ischemic postconditioning, ST-segment elevation myocardial infarction, Time of one cycle, Primary percutaneous coronary intervention

中图分类号:

R541

胡浩然,袁梦,梁丽宁,季宪飞,李涛,陈永,刘福利,边红军,周轶,胡波,钟霞,商德亚. 心肌缺血后适应循环时间对急诊经皮冠状动脉介入治疗患者的影响[J]. 山东大学学报（医学版）, 2016, 54(2): 57-62.

HU Haoran, YUAN Meng, LIANG Lining, JI Xianfei, LI Tao, CHEN Yong, LIU Fuli, BIAN Hongjun, ZHOU Yi, HU Bo, ZHONG Xia, SHANG Deya. Effect of the cycle time of myocardial ischemic postconditioning on patients undergoing primary percutaneous coronary intervention[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(2): 57-62.

参考文献

[1] O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J]. J Am Coll Cardiol, 2013, 61(4): 485-510.
[2] Zhao ZQ, Corvera JS, Halkos ME, et al. Inhibition of myocardial injury by ischemic postconditioning during reperfusion: comparison with ischemic preconditioning[J]. Am J Physiol Heart Circ Physiol, 2003, 285(2): 579-588.
[3] Cerqueira MD, Weissman NJ, Dilsizian V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association[J]. Int J Cardiovasc Imaging, 2002, 18(1): 539- 542.
[4] Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium[J]. Circulation, 1986, 74(5): 1124-1136.
[5] Lie RH, Hasenkam JM, Nielsen TT, et al. Post-conditioning reduces infarct size in an open-chest porcine acute ischemia-reperfusion model[J]. Acta Anaesthesiol Scand, 2008, 52(9): 1188-1193.
[6] Liu ZZ, Kong JB, Li FZ, et al. Ischemic postconditioning decreases matrix metalloproteinase-2 expression during ischemia-reperfusion of myocardium in a rabbit model: A preliminary report[J]. Exp Clin Cardiol, 2013, 18(2): 99-101.
[7] He H, Li N, Zhao Z, et al. Ischemic postconditioning improves the expression of cellular membrane connexin 43 and attenuates the reperfusion injury in rat acute myocardial infarction[J]. Biomed Rep, 2015, 3(5): 668-674.
[8] Zhao ZQ, Corvera JS, Halkos ME, et al. Inhibition of myocardial injury by ischemic postconditioning during reperfusion: comparison with ischemic preconditioning[J]. Am J Physiol Heart Circ Physiol, 2003, 285(2): 579-588.
[9] Tong G, Aponte AM, Kohr MJ, et al. Postconditioning leads to an increase in protein S-nitrosylation[J]. Am J Physiol Heart Circ Physiol, 2014, 306(6): 825-832.
[10] Najafi M, Farajnia S, Mohammadi M, et al. Inhibition of mitochondrial permeability transition pore restores the cardioprotection by postconditioning in diabetic hearts[J]. J Diabetes Metab Disord, 2014, 13(1): 1-10.
[11] 马燚, 尚小明, 李莉, 等. 缺血后适应对老年急性心肌梗死患者的影响[J]. 中华老年心脑血管病杂志, 2011, 3(3): 231-234. MA Yan, SHANG Xiaoming, LI Li, et al. Effect of ischemic postconditioning on elderly patients with acute myocardial infarction[J]. Chinese Journal of Geriatric Heart Brain and Vessel Diseases, 2011, 3(3): 231-234.
[12] Lin XM, Zhang ZY, Wang LF, et al. Attenuation of tumor necrosis factor-alpha elevation and improved heart function by postconditioning for 60 seconds in patients with acute myocardial infarction[J]. Chin Med J(Engl), 2010, 123(14): 1833-1839.
[13] Kin H, Zhao ZQ, Sun HY, et al. Postconditioning attenuates myocardial ischemia–reperfusion injury by inhibiting events in the early minutes of reperfusion[J]. Cardiovasc Res, 2004, 62(1): 74-85.
[14] Zhao CM, Yang XJ, Yang JH, et al. Effect of ischemic postconditioning on recovery of left ventricular contractile function after acute myocardial infarction[J]. J Int Med Res, 2012, 40(3): 1082-1088.
[15] Kim EK, Hahn JY, Song YB, et al. Effect of ischemic postconditioning on myocardial salvage in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: cardiac magnetic resonance substudy of the POST randomized trial[J]. Int J Cardiovasc Imaging, 2015, 31(3): 629-637.
[16] Hahn JY, Song YB, Kim EK, et al. Ischemic postconditioning during primary percutaneous coronary intervention: the effects of postconditioning on myocardial reperfusion in patients with ST-segment elevation myocardial infarction(POST)randomized trial[J]. Circulation, 2013, 128(17): 1889-1896.
[17] Halkin A, Stone GW, Grines CL, et al. Prognostic implications of creatine kinase elevation after primary percutaneous coronary intervention for acute myocardial infarction[J]. J Am Coll Cardiol, 2006, 47(5): 951-961.
[18] Chia S, Senatore F, Raffel OC, et al. Utility of cardiac biomarkers in predicting infarct size, left ventricular function, and clinical outcome after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction[J]. JACC Cardiovasc Interv, 2008, 1(4): 415-423.

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