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目的探讨在急性心肌梗死(acute myocardial infarction,AMI)直接经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)中缺血后适应(ischemic postconditioning,IPC)对梗死相关动脉(Infarction Related Artery,IRA)不同开通时间再灌注心肌的保护作用。方法观察直接PCI的首次AMI患者305例,按照发病至IRA开通时间以6h为界限,分为早期组(<6h)和晚期组(6~12h),每组依据再灌注开始3min内,是否给予后适应处理分为早期常规组(PE)和早期后适应组(IE)及晚期常规组(PL)和晚期后适应组(IL)。术后即刻及术后6个月行超声心动图检查,测定心尖四腔切面二尖瓣环部侧壁缘舒张晚期峰流速(Aa)、舒张早期峰速度(Ea),收缩期峰流速(S),并计算Ea/Aa。随访至术后6个月,观察临床转归。结果 1早期后适应组的Ea/Aa及S的变化值即心功能改善情况优于早期常规组、晚期后适应组及晚期常规组,差异有统计学意义(P<0.05),晚期后适应组与晚期常规组比较差异无统计学意义(P>0.05);2随访期内早期后适应组转归明显优于早期常规治疗组及晚期后适应组,差异有统计学意义(P<0.05)。结论缺血后适应在急性心肌梗死直接冠脉成形术中,可改善左心室心肌重构,提高左心室功能,尤其对于冠脉开通相对较早的患者,可改善其转归。
Objective To investigate the effect of ischemic postconditioning (IPC) on Infarction Related Artery (IRA) in patients with acute myocardial infarction (AMI) under direct percutaneous coronary intervention (PCI) The protective effect of reperfusion myocardium at the time of opening. Methods The first AMI patients with direct PCI were enrolled in this study. 305 patients were divided into early group (<6h) and late group (6 ~ 12h) according to the time of onset of IRA to 6h. Each group was given within 3min after reperfusion Postconditioning treatment was divided into early routine group (PE) and early postconditioning group (IE), late routine group (PL) and late postconditioning group (IL). Echocardiography was performed immediately after operation and 6 months after operation to measure the peak diastolic peak velocity (Aa), early diastolic peak velocity (Ea), systolic peak velocity (S ) And calculate Ea / Aa. Follow-up to 6 months after operation, the clinical outcome was observed. Results 1 The changes of Ea / Aa and S in early postconditioning group were better than those in early routine group, late postconditioning group and late routine group (P <0.05), and those in late postconditioning group There was no significant difference between the two groups (P> 0.05). The prognosis of the early postoperative group was significantly better than that of the early routine group and the late postoperative group (P <0.05). Conclusions Post-ischemic postconditioning can improve left ventricular remodeling and improve left ventricular function in patients undergoing direct coronary angioplasty of acute myocardial infarction, especially in patients with relatively earlier coronary artery opening.