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目的:探讨缺血后适应在急诊经皮冠状动脉介入治疗(PCI)中应用的临床价值。方法:43例急性心肌梗死的患者随机分成2组:后适应组(25例)在行PCI时于血流开通即刻接受后适应治疗,对照组(18例)接受常规PCI。2组患者均于PCI后定时取静脉血测血清肌酸磷酸激酶同工酶(CK-MB)浓度,入院时和术后24 h取静脉血测血清超敏C反应蛋白浓度,入院时和术后2 h行心电图检查,术后第7天行心脏超声和SPECT静息心肌灌注显像。结果:后适应组CK-MB峰值低于对照组[(280.7±120.0)∶(374.9±146.8)U/L,P<0.05],其CK-MB曲线下面积也较对照组小[(6 125±2 136)∶(8 643±3 779)%,P<0.05]。入院时血清超敏C反应蛋白浓度2组无明显差异[(5.0±2.8)∶(4.8±2.2)mg/L,P>0.05],但术后24 h后适应组该浓度低于对照组[(6.1±4.8)∶(9.6±5.0)mg/L,P<0.05]。后适应组术后2 h ST段完全回落者较对照组多(88%∶55.6%,P<0.05),术后第7天后适应组左室射血分数高于对照组(55.04±11.23%∶47.81±7.78%,P<0.05),而室壁运动计分指数明显低于对照组(1.27±0.22∶1.44±0.30,P<0.05)。SPECT半定量分析显示术后第7天时后适应组心肌缺血面积、心肌坏死面积和坏死缺血比分别为(27±15)%、(14±11)%、(46±29)%,对照组分别为(37±14)%、(25±11)%、(67±20)%,2组比较,分别为P<0.05、P<0.01、P<0.05。结论:急诊PCI中运用缺血后适应处理能改善心肌灌注,减轻炎症反应,减少心肌坏死。
Objective: To investigate the clinical value of post-ischemic postoperative adaptation in emergency percutaneous coronary intervention (PCI). Methods: Forty-three patients with acute myocardial infarction were randomly divided into two groups: control group (n = 18) underwent conventional PCI after PCI. Serum creatine phosphokinase isoenzyme (CK-MB) concentrations were measured at 2 h after PCI in both groups. Venous blood was collected for serum hs-CRP concentrations at admission and 24 h after PCI. Electrocardiogram was performed 2 h after the operation, and echocardiography and SPECT resting myocardial perfusion imaging were performed on the 7th postoperative day. Results: The peak area of CK-MB in postconditioning group was lower than that in control group [(280.7 ± 120.0) vs (374.9 ± 146.8) U / L, P <0.05] ± 2 136): (8 643 ± 3 779)%, P <0.05]. Serum high sensitivity C-reactive protein concentrations at admission were not significantly different between the two groups [(5.0 ± 2.8) vs (4.8 ± 2.2) mg / L, P> 0.05) (6.1 ± 4.8): (9.6 ± 5.0) mg / L, P <0.05]. In the postoperative group, the ST segment completely recovered more than the control group 2 h after operation (88% vs 55.6%, P <0.05), and the left ventricular ejection fraction was higher in the adaptive group than in the control group on the 7th day after operation (55.04 ± 11.23% 47.81 ± 7.78%, P <0.05), while the wall motion score index was significantly lower than that of the control group (1.27 ± 0.22:1.44 ± 0.30, P <0.05). Semiquantitative SPECT analysis showed that the areas of myocardial ischemia, myocardial necrosis and necrosis after 7 days postoperatively were (27 ± 15)%, (14 ± 11)% and (46 ± 29)%, respectively (37 ± 14)%, (25 ± 11)% and (67 ± 20)% respectively in the two groups, P <0.05, P <0.01, P <0.05 respectively. Conclusion: The use of post-ischemic postconditioning in emergency PCI can improve myocardial perfusion, reduce inflammation and reduce myocardial necrosis.