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目的探讨缺血后适应的心肌保护作用。方法41例首次发生急性心肌梗死的患者随机分入对照组(n=18)和缺血后适应组(n=23)。各例接受急诊PTCA治疗。对照组梗死血管再通后3min内不施加干预;缺血后适应组梗死血管再通后1min内应用低气压充盈和回撤球囊,每一过程各30s。术后观察梗死血管TIMI血流、心肌Blush分级、72h内肌酸磷酸激酶(CK)、术后2hST段回落,出院前左心室射血分数等指标,与对照组进行比较。结果术后2hST段回落、梗死血管TIMI血流、心肌Blush分级两组差异无统计学意义。缺血后适应组72h内CK平均值连线的曲线下面积显著减低(58002比79787,P=0.04)。结论急诊PTCA缺血后适应过程能够通过减少心肌梗死面积减轻再灌注损伤,提供心肌保护作用。
Objective To investigate the myocardial protection after ischemic adaptation. Methods Totally 41 patients with acute myocardial infarction were randomly divided into control group (n = 18) and ischemic postconditioning group (n = 23). Cases received emergency PTCA treatment. In the control group, no intervention was given within 3 min after recanalization of the infarct. After the ischemic postconditioning group, the balloon was filled and retracted within 1 min after the recanalization of the infarct. Each procedure was performed for 30 s. The infarct blood vessel TIMI flow, Blush grading of myocardium, creatine phosphokinase (CK) within 72 hours, fall of 2 h after surgery, and left ventricular ejection fraction before discharge were compared with those of the control group. Results There was no significant difference between the two groups at 2h after operation, TIMI flow in infarcted blood vessels and Blush grading in myocardial infarction. The area under the curve of the mean CK connection within 72 h of ischemic postconditioning group was significantly lower (58002 vs. 79787, P = 0.04). Conclusions The post-ischemic postconditioning of PTCA can provide myocardial protection by reducing the area of myocardial infarction and reperfusion injury.