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目的:用肢体缺血后处理的方法,干预直接经皮冠状动脉介入治疗(PCI)急性ST段抬高型心肌梗死(STEMI),以减轻心肌缺血再灌注损伤。方法:对拟行直接PCI的急性STEMI患者62例,用随机数字法分为肢体缺血后处理(LIPost)组30例和常规对照(NC)组32例。LIPost组在球囊首次扩张梗死相关血管(IRA)前,用血压计袖带缠绕于上臂并充气达250mmHg(1mmHg=0.133kPa),持续5min后放气,间隔5min后重复1次;NC组不作预处理。比较2组术后IRA心肌梗死溶栓试验血流分级(TIMI)、梗死相关区域(IRZ)心肌呈色分级(MBG)、ST段抬高回落指数(STR)、再灌注心律失常(RA)和心肌钙蛋白I(cTnI)峰值前移的发生率,以及症状至球囊扩张时间(SOTB)。结果:2组患者的主要基线指标无统计学差异。2组患者IRA前向血流达TIMI 3级和cTnI峰值前移的获得率相似(96.7%∶96.9%,P=1.000;93.3%∶84.4%,P=0.476),差异无统计学意义。与NC组相比,LIPost组MBG≥2级和STR≥50%获得率较高(80.0%∶56.3%,P=0.046;83.3%∶59.4%,P=0.038),差异有统计学意义;RA发生率较低(30.0%∶56.3%,P=0.037),差异有统计学意义。2组SOTB相似(6.4±3.3∶5.6±3.0,P=0.339),差异无统计学意义。结论:急性STEMI直接PCI时,肢体缺血后处理可有效减轻心肌再灌注损伤,且不影响症状至球囊扩张时间。
OBJECTIVE: To investigate the effects of limb ischemic postconditioning on acute myocardial infarction (STEMI) induced by direct percutaneous coronary intervention (PCI) to reduce myocardial ischemia-reperfusion injury. Methods: Sixty-two patients with acute STEMI who underwent direct PCI were divided into three groups according to random number: 30 cases of LIPost group and 32 cases of control group. The LIPost group was inflated with a sphygmomanometer cuff on the upper arm and inflated to 250 mmHg (1 mmHg = 0.133 kPa) for 5 min before the balloon was inflated for the first time in the infarct-related vessels (IRA) Pretreatment. TIMI, MBG, STR, reperfusion arrhythmia (RA) and myocardial infarct size were compared between two groups after operation. The incidence of peak cardiac troponin I (cTnI) and the time from symptom to balloon dilatation (SOTB). Results: There were no significant differences in the main baseline parameters between the two groups. There was no significant difference in the rates of forward TIMI 3 and cTnI peak forward IRF in both groups (96.7%: 96.9%, P = 1.000; 93.3%: 84.4%, P = 0.476). Compared with NC group, the acquisition rates of MBG≥2 and STR≥50% were higher in LIPost group (80.0%: 56.3%, P = 0.046; 83.3%: 59.4%, P = 0.038) The incidence was lower (30.0%: 56.3%, P = 0.037), the difference was statistically significant. The SOTB in the two groups was similar (6.4 ± 3.3: 5.6 ± 3.0, P = 0.339), with no significant difference. Conclusion: In the acute STEMI direct PCI, limb ischemic postconditioning can effectively reduce myocardial reperfusion injury, and does not affect the symptoms to the time of balloon dilatation.