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目的探讨肢体远隔缺血后适应(RIPost C)对急性ST段抬高型心肌梗死(STEMI)患者心肌缺血再灌注损伤的影响。方法选择STEMI并在心导管室行急诊直接经皮冠脉介入治疗(PPCI)患者80例。随机分为PPCI+RIPost C组(n=36)和PPCI组(n=44),两组均接受PPCI。PPCI+RIPost C组在球囊扩张3 min内针对上肢行RIPost C。受试者术前和术后0.5、8、24、48、72 h共抽取静脉血6次测定血清肌酸磷酸激酶同工酶(CK-MB)浓度。术后第7天应用心脏超声评估左心室射血分数(LVEF)。结果(1)PPCI+RIPost C组CK-MB峰值明显减低〔(280.60±45.83)ng/ml vs(352.21±65.42)ng/ml,P<0.01〕;PPCI+RIPost C组CK-MB曲线下面积中位数为717.25(364.63~921.98),PPCI组曲线下面积中位数为807.00(693.30~1 136.00),PPCI+RIPost C组较PPCI组CK-MB曲线下面积明显减低(P<0.05)。(2)PPCI+RIPost C组术后第7天LVEF显著高于PPCI组〔(54.50±9.73)%vs(48.14±7.04)%,P=0.01〕。结论针对上肢行RIPost C可以降低STEMI患者心肌坏死面积、提高患者LVEF,提示RIPost C对STEMI患者心肌缺血再灌注损伤有保护作用。
Objective To investigate the effect of limb ischemic postconditioning (RIPost C) on myocardial ischemia-reperfusion injury in acute ST-segment elevation myocardial infarction (STEMI). Methods Eighty patients with STEMI who underwent emergency percutaneous coronary intervention (PPCI) in the cardiac catheterization room were enrolled. Randomly divided into PPCI + RIPost group C (n = 36) and PPCI group (n = 44), both groups received PPCI. PPCI + RIPost group C RIPost C for upper limbs within 3 min of balloon dilatation. Serum creatine phosphokinase isoenzyme (CK-MB) concentrations were measured 6 and 6 hours after operation in 0.5, 8, 24, 48 and 72 h after operation. On the seventh postoperative day, left ventricular ejection fraction (LVEF) was assessed by echocardiography. Results The peak area of CK-MB in PPCI + RIPost C group was significantly lower than that in PPCI + RIPost C group (280.60 ± 45.83 ng / ml vs 352.21 ± 65.42 ng / ml, P <0.01) The median area under curve of PPCI group was 807.00 (693.30-1 136.00). The area under curve of CK-MB in PPCI + RIPost group C was significantly lower than that in PPCI group (P <0.05). (2) LVEF of PPCI + RIPost group C was significantly higher than that of PPCI group on the seventh postoperative day [(54.50 ± 9.73)% vs (48.14 ± 7.04)%, P = 0.01〕. Conclusions RIPost C for upper extremity can reduce the area of myocardial necrosis and increase the LVEF in patients with STEMI, suggesting that RIPost C has a protective effect on myocardial ischemia-reperfusion injury in STEMI patients.