|本期目录/Table of Contents|

[1]王昆仑,张守彦,薛书峰,等.缺血后适应对65 岁以下急性ST 段抬高型心肌梗死患者的心脏保护作用[J].慢性病学杂志,2017,(02):131-134.
　WANG Kun-lun,ZHANG Shou-yan,XUE Shu-feng,et al.Effect of ischemic postconditioning on acute ST-segment elevation myocardial infraction patients under 65 years of age[J].,2017,(02):131-134.
点击复制

缺血后适应对65 岁以下急性ST 段抬高型心肌梗死患者的心脏保护作用(PDF)

《慢性病学杂志》[ISSN:1674-8166/CN:11-5900/R]

卷:
期数:
2017年02期
页码:
131-134
栏目:
论著
出版日期:
2017-03-27

文章信息/Info

Title:
Effect of ischemic postconditioning on acute ST-segment elevation myocardial infraction patients under 65 years of age
作者:
王昆仑; 张守彦; 薛书峰; 郑卫峰; 陈伟刚
河南省洛阳市中心医院，河南洛阳471000
Author(s):
WANG Kun-lun;  ZHANG Shou-yan;  XUE Shu-feng;  ZHENG Wei-feng;  CHEN Wei-gang
Department of Cardiology, Luoyang Central Hospital, Luoyang, Henan 471000, China Corresponding author: ZHANG Shou-yan, E-mail: zsydoctor@163.com
关键词:
急性ST 段抬高型心肌梗死; 缺血后适应; 经皮冠状动脉介入; 心肌梗死面积
Keywords:
Acute ST- segment elevation myocardial infarction;  Ischemic postconditioning;  Percutaneouscoronary intervention;  Infarct size
分类号:
R542.22
DOI:
-
摘要:
目的探讨缺血后适应（IPOC） 能否减少65 岁以下且总缺血时间＜6 h 的急性ST 段抬高型心肌梗死 （STEMI） 患者的心肌梗死面积，改善患者心功能。方法将122 例患者随机分为观察组（62 例） 和对照组 （60 例）。其中对照组采用IPOC 干预。观察两组患者经皮冠状动脉介入治疗（PCI） 术后心肌肌钙蛋白I （cTnI） 、肌酸激酶同工酶（CK- MB） 峰值、3 个月后心脏彩超左心射血分数（LVEF）、左室舒张末期容积 （LVEDD）、6 个月后心脏磁共振（CMR） 心肌梗死面积大小有无差异。结果两组患者PCI 术前cTnI、CKMB 值比较，差异无统计学意义（P>0.05）；但PCI 术后，观察组cTnI、CK- MB 峰值明显低于对照组（P< 0.05）；术后3 个月，观察组LVEF、LVEDD 明显优于对照组（P<0.05）。PCI术后6 个月，CMR 测得梗死面积 观察组明显低于对照组（P<0.05）。结论IPOC 能够减少65岁以下总缺血时间小于＜6 h的急性STEMI患者 的心肌梗死面积，改善心功能。
Abstract:
Objective To investigate whether ischemic postconditioning （IPOC） can reduce infract size and improve ventricular function in acute ST-segment elevation myocardial infraction （STEMI） patients under 65 years of age and total ischemic time was less than 6 hours. Methods A total of 136 patients were randomly divided into IPOC group and control group. Cardiac troponin I （cTnI） peaks and creatine kinase-MB （CK-MB） peaks after PCI, left ventricular ejection fraction （LVEF） and left ventricular end-diastolic dimension （LVEDD） after three months, infarct size measured by cardiac magnetic resonance after 6 months were recorded and the results were compared between the two groups. Results There was no significant difference in cTnI and CK- MB values before PCI （P>0.05） between two groups. However, the cTnI peak and CK-MB peak values of IPOC group were remarkably lower than those of the control group （P<0.05）. At the time of admission, there was no significant difference in the LVEF and LVEDD values between the two groups, but three months after PCI the LVEF and WMSI values of IPOC group were significantly better than those of the control group （P<0.05）. Infarct size 6 months after PCI in IPOC group was obviously lower than that in the control group （P<0.05）. Conclusion IPOC can reduce infract size and improve ventricular function in acute STEMI patients under 65 years of age and total ischemic time was less than 6 hours.

参考文献/References:

[1] Mandelzweig L, Battler A, Boyko V, et al. The second European Heart Survey on acute coronary syndromes: characteristics, treatment,and outcome of patients with ACS in Europe and the Mediterranean Basinin [J]. Eur Heart J, 2004(27):2285-2293.
[2] Steg PG, James SK, Atar D, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST- segment elevation [J]. Eur Heart J, 2012(33):2569-2619.
[3] Verma S, Fedak PW, Weisel RD, et al. Fundamentals of reperfusion injury for the clinical cardiologist [J]. Circulation, 2002(105):2332-2336.
[4] Zhao ZQ, Corvera JS, Halkos ME, et al. Inhibition ofmyocardial injury by ischemic postconditioning during reperfusion： comparison with ischemic preconditioning [J]. Am J Physiol Heart Circ Physiol, 2003,285(2):H579-588
[5] 罗富良,孙嘉康,唐跃,等. 缺血后适应对大鼠移植心脏心肌细胞 凋亡的影响[J].中国循环杂志,2012,4(27):470-472.
[6] Freixa X, Bellera N, Ortiz- Perez JT, et al. Ischaemic postconditioning revisited: Lack of effects on infarct size following primary percutaneous coronary intervention [J]. Eur Heart J, 2012(33):103-112.
[7] Tarantini G, Favaretto E, Marra MP, et al. Postconditioning during coronary angioplasty in acute myocardial infarction: The POST- AMI trial [J]. Int J Cardiol, 2012(162): 33-38.
[8] Yellon DM, Hausenloy DJ. Myocardial reperfusion injury [J]. N Engl J Med, 2007(357):1121-1135.
[9] Somers SJ, LacerdaL, Opie L, et al. Age，genetic characteristics and number of cycles are critical factors to consider for successful protection ofthe murine heart with postconditioning [J]. Physiol Res, 2011,60(6):971-974.
[10] Zhou C, Yao Y, Zheng Z, et al. Stenting technique, gendeg and age are associated with cardioprotection by ischaemic postconditioning in primary coronary intervention: a systematic review of 10 randomized trials [J]. Eur Heart J, 2012,33(24):3070-3077.
[11] 杨伟,金惠根,刘宗军,等. 急性心肌梗死不同时间窗缺血后适应对急诊冠状动脉介入治疗疗效的影响[J].上海医学,2008,31(10): 694-699.
[12] Sorensson P, Ryden L, Saleh N, et al. Long- term impact of postconditioning on infarct size and left ventricular ejection fraction in patients with ST- elevation myocardial infarction [J]. BMC Cardiovasc Disord, 2013(13):22.
[13] Ovize M, Mewton N. Interventional cardiology: Ischaemic POSTconditioning- a long harvest for a little corn [J]. Nat Rev Cardiol, 2014,11(1):8-10.
[14] Hallén J. Troponin for the estimation of infarct size: what have we learned [J]. Cardiology, 2012,121(3):204-212.

备注/Memo

备注/Memo:
作者简介：王昆仑，硕士，研究方向：冠心病介入及心衰的治疗 通信作者：张守彦，E-mail：zsydoctor@163.com
更新日期/Last Update: 2017-02-18