缺血后处理对急性心肌梗死介入治疗患者的心脏保护作用

摘要

目的 探讨缺血后处理(I-postC)对接受急诊介入治疗的急性心肌梗死(AMI)患者的心脏保护作用.方法 检索1998年1月至2011年5月各中文医学数据库中关于AMI患者接受急诊介入治疗过程中应用I-postC的文献.进行文献筛选和质量评价后,利用RevMan4.2软件进行Meta分析.结果 共纳入文献7篇,总病例数为519例,其中I-postC组234例,对照组285例.与对照组比较,I-postC能明显降低AMI患者的肌酸激酶(CK)酶峰(WMD:-356.72 IU/L,95%CI:-541.33～-199.11 IU/L,P<0.000 01)、肌酸激酶MB型同工酶(CK-MB)酶峰(WMD:-39.45 IU/L,95%CI:-54.53～-24.37 IU/L,P<0.000 01)以及再灌注心律失常的发生(OR:0.41,95%CI:0.25～0.66,P=0.000 3),并改善AMI患者左心室射血分数(LVEF)(WMD:0.03,95%CI:0.02～0.03,P<0.000 01).结论 I-postC对缺血心脏有明显的保护作用,具有较大的临床应用价值.%Objective To explore cardioprotective effects of ischemic postconditioning (I-postC) on patients with acute myocardial infarction who had accepted emergency interventional therapy. Methods Literature from January 1998 to May 2011 related to I-postC application in patients with AMI who had accepted emergency interventional therapy were searched in all Chinese medical databases. After literature screening and quality assessment,RevMan 4. 2 software was utilized for Meta-analysis. Results A total of 7 literatures were enrolled with total 519 cases. 234 cases of them were in I-postC groups and 285 cases in control groups. Compared with control group, I-postC significantly reduced the creatine kinase(CK) peak value(WMD: - 356. 72 IU/L,95%C7:-514. 33- -199. 11 IU/L, P< 0.000 01), creatine kinase MB isoenzyme(CK-MB) peak value(WMD: -39. 45 IU/L,95%C7:-54. 53- -24. 37 IU/L,P<0. 000 01) and occurrence of reperfusion-induced arrhythmia (OR : 0. 41, 95%CI:0. 25 -0. 66,P = 0. 000 3) in patients with AMI. I-postC was also found to improve left ventricular ejection fraction(LVEF) of patients with AMI(WMD:0. 03,95%CI:0. 02 - 0. 03,P<0. 000 01). Conclusion I-postC possesses significantly protective effect on ischemic heart with great value in clinical application.