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目的探讨缺血后适应(IPOC)能否减少65岁以下且总缺血时间<6 h的急性ST段抬高型心肌梗死(STEMI)患者的心肌梗死面积,改善患者心功能。方法将122例患者随机分为观察组(62例)和对照组(60例)。其中对照组采用IPOC干预。观察两组患者经皮冠状动脉介入治疗(PCI)术后心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)峰值、3个月后心脏彩超左心射血分数(LVEF)、左室舒张末期容积(LVEDD)、6个月后心脏磁共振(CMR)心肌梗死面积大小有无差异。结果两组患者PCI术前cTnI、CKMB值比较,差异无统计学意义(P>0.05);但PCI术后,观察组cTnI、CK-MB峰值明显低于对照组(P<0.05);术后3个月,观察组LVEF、LVEDD明显优于对照组(P<0.05)。PCI术后6个月,CMR测得梗死面积观察组明显低于对照组(P<0.05)。结论 IPOC能够减少65岁以下总缺血时间小于<6 h的急性STEMI患者的心肌梗死面积,改善心功能。
Objective To investigate whether post-ischemic postconditioning (IPOC) can reduce myocardial infarction size and improve cardiac function in patients with acute ST-segment elevation myocardial infarction (STEMI) under 65 years of age with a total ischemic time of <6 h. Methods 122 patients were randomly divided into observation group (62 cases) and control group (60 cases). The control group used IPOC intervention. The cardiac troponin I (cTnI) and creatine kinase MB (CK-MB) were measured in two groups after percutaneous coronary intervention (PCI). The left ventricular ejection fraction (LVEF) ), Left ventricular end-diastolic volume (LVEDD) and myocardial infarction size after 6 months. Results There was no significant difference in cTnI and CKMB between the two groups before PCI (P> 0.05). However, the peak values of cTnI and CK-MB in the observation group were significantly lower than those in the control group after PCI (P <0.05) At 3 months, LVEF and LVEDD in observation group were significantly better than those in control group (P <0.05). At 6 months after PCI, infarct size measured by CMR was significantly lower in the observation group than in the control group (P <0.05). Conclusions IPOC can reduce myocardial infarct size and improve cardiac function in acute STEMI patients under 65 years of age with an overall ischemic time less than 6 h.