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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-M B),术后72 h检测心肌肌钙蛋白I(c TNI),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 c TNI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-M B峰值、72 h c TNI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。
Objective To investigate the clinical and prognostic effects of different ischemic postconditioning cycles on patients undergoing emergency percutaneous coronary intervention (PCI). Methods One hundred patients with acute ST-segment elevation myocardial infarction were randomly divided into 4 groups: conventional PCI group (n = 25) received conventional PCI; IPOC-1 group (n = 25) IPOC-2 group (n = 25) began to perform repeated low pressure (4-6 cycles) for 1 min after opening of the anterior descending artery atm) inflated and deflated the balloon three times, the first 30 s, the second 60 s, the third 90 s; IPOC-3 group (n = 25) Low pressure (4 ~ 6 atm) filling and retracting balloon 3 times, 60 s / time. Creatine kinase MB was detected at 4, 8, 12, 16, 20, 24, 48 and 72 h after operation. Cardiac troponin I (c TNI) (Hs-CRP) were measured at 24 h after operation. Corrected TIMI frames (CTFCs) were calculated after operation. Echocardiography and single electron emission computed tomography (SPECT) were performed at 7 and 3 months after operation. )an examination. Results Compared with the conventional PCI group, the peak values of CK-MB and the concentration of 72 h c TNI in IPOC-1, IPOC-2 and IPOC-3 groups were significantly decreased (P <0.05). Compared with IPOC-1 group and IPOC-3 group, the serum CK-M B peak and 72 h c TNI concentration of IPOC-2 group were significantly decreased (P <0.05). There was no significant difference in hs-CRP concentration between the four groups before operation (P> 0.05). Serum hs-CRP concentration at 24 h after operation was the lowest (P <0.05) in IPOC-2 group. Compared with the conventional PCI group, IPOC-1 group and IPOC-3 group, the CTFC of IPOC-2 group was significantly lower (P <0.05). There was no significant difference in LVEDD, Ea / Aa and LVEF between the groups on the 7th day after surgery (P> 0.05). The SPECT score in the IPOC-2 group was the lowest among the 4 groups (P <0.05). There was no significant difference in LVEDD between the 4 groups after 3 months (P> 0.05). Compared with the conventional PCI group, the IPOC-1 group and the IPOC-3 group, the LVEF and Ea / Aa in the IPOC- P <0.05). The SPECT score showed the lowest in the IPOC-2 group (P <0.05). The SPECT score at 3 months after operation was significantly lower than that at 7 days after operation (P <0.05). Conclusion Myocardial ischemic postconditioning is conducive to reduce myocardial infarct size, reduce myocardial reperfusion injury and improve cardiac contractility and diastolic function.