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目的探讨缺血后适应(ischemic postconditioning,IPC)对PCI治疗的急性前壁心肌梗死患者的心肌保护作用。方法选择直接PCI的首次急性前壁心肌梗死AMI患者196例,依据再灌注开始3min内,是否给予30s再灌注/30s再闭塞的3次循环,随机分为IPC组和常规PCI组。监测二组患者术前至术后1周血脑钠肽(brain natriuretic peptide,BNP)水平变化,术前、术后1个月、术后12个月行超声心动图检查,应用双平面simpson法测定左室射血分数(left ventricular ejection fraction,LVEF),对左心室收缩功能进行评估。依据随访12个月时测得的LVEF是否大于45%将患者分成二组:LVEF值作为因变量,从具有统计学意义的指标中提取的候选参数作为自变量,进行Logistic回归分析。结果二组患者血BNP水平术前比较差异无统计学意义,术后24h及第七天各时间点比较差异有统计学意义(P<0.05);二组患者LVEF术前比较差异无统计学意义(P>0.05),术后1个月及12个月比较差异有统计学意义(P<0.05);Logistic回归分析发现影响AMI患者PCI术后远期心功能的独立危险因素包括后适应实施与否。结论 (1)缺血后适应在急性前壁心肌梗死直接冠脉成形术中,可降低心室壁张力,通过改善左心室心肌重构,提高左心室收缩功能。(2)缺血后适应作为独立危险因素影响急性前壁心肌梗死患者PCI术后的心功能。
Objective To investigate the myocardial protective effect of ischemic postconditioning (IPC) on patients with acute anterior myocardial infarction (PCI) treated with PCI. Methods A total of 196 AMI patients with acute AMI undergoing direct PCI were randomly divided into IPC group and PCI group according to 3 cycles of 30 seconds reperfusion and 30 seconds reperfusion occlusion within 3 minutes after reperfusion. The levels of brain natriuretic peptide (BNP) in the two groups were monitored before and one month after operation and echocardiography at 12 months after operation. The biplane simpson method Left ventricular ejection fraction (LVEF) was measured to assess left ventricular systolic function. Patients were divided into two groups based on whether the LVEF measured at 12 months of follow-up was greater than 45%. Logistic regression analysis was performed using LVEF values as dependent variables and candidate parameters extracted from statistically significant indicators as independent variables. Results There was no significant difference in blood BNP level between the two groups before operation, and there was significant difference at each time point between the second and fourth postoperative days (P <0.05). There was no significant difference in preoperative LVEF between the two groups (P> 0.05). The difference was statistically significant at 1 month and 12 months after operation (P <0.05). Logistic regression analysis showed that independent risk factors of long-term cardiac function after PCI in AMI patients included post- no. Conclusions (1) In ischemic postconditioning, in acute anterior myocardial infarction with direct coronary angioplasty, the ventricular wall tension can be decreased and left ventricular systolic function can be improved by improving left ventricular remodeling. (2) Post-ischemic adaptation as an independent risk factor affects cardiac function in patients with acute anterior myocardial infarction after PCI.