远程缺血后适应对急性心肌梗死患者的保护作用

摘要

目的：探讨远程缺血后适应（ RIPC）对急性ST段抬高型心肌梗死患者的心肌保护作用及相关机制。方法将49例急性ST段抬高型心肌梗死患者随机分为2组：冠状动脉介入治疗（ PCI）＋RIPC组（ PCI＋RIPC组，n＝24），行急诊PCI手术，于开通血管后5 min内行RIPC处理；单纯PCI组（n＝25），行常规急诊PCI手术。所有患者均于术前及术后2 h行心电图检查，术后24 h取静脉血检测血清超敏C反应蛋白（ hs－CRP）。结果PCI＋RIPC组2 h ST段完全回落百分比高于对照组（79．2％vs．40．0％，P＜0．05），术后24 h PCI＋RIPC组血清hs－CRP浓度较单纯PCI组有所降低〔（7．76±3．12）mg／L vs．（10．51±2．83） mg／L，P＜0．05〕。结论对于行急诊PCI术的急性ST段抬高型心肌梗死患者，RIPC处理能改善心肌灌注，起到心肌保护作用。%Objective To explore the cardioprotective effect of remote ischemic postconditioning ( RIPC) in patients with acute ST segment elevation myocardial infarction and the related mechanisms .Methods A total of 49 patients with acute ST segment elevation myocardial infarction were randomly divided into 2 groups:percutaneous coronary intervention (PCI) +remote ischemic postconditioning (RIPC)group (PCI+RIPC group, n=24) received RIPC 5 min after PCI;PCI group (n=25) just received conventional emergency PCI .Electrocardiogram was recorded before and 2 h after PCI. Venous blood samples for high sensitive C -reactive protein (hs-CRP) were obtained at 24 h after PCI.Results Com-pared with PCI group, more patients in PCI+RIPC group had complete ST resolutions (79.2%vs.40.0%,P<0.05). The levels of hs-CRP in PCI+RIPC group was lower than in PCI group [(7.76 ±3.12)mg/L vs.(10.51 ±2.83) mg/L,P <0.05] at 24 h after PCI.Conclusion This study indicates that RIPC in emergency PCI for patients with acute ST segment elevation myocardial infarction can improve myocardial perfusion and plays an important role in protecting the heart.