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目的研究早期及晚期远程缺血预适应对不稳定型心绞痛经皮冠状动脉介入治疗(PCI)患者的不同影响。方法连续入选2014年1月至2016年1月于粤北人民医院择期行PCI术不稳定型心绞痛患者160例,其中晚期远程缺血预适应组(80例)PCI术前3 d开始行右上肢缺血预适应,用血压计袖带压迫肱动脉。将血压计加压至200 mmHg(1 mmHg=0.133 k Pa),持续5 min后放气休息,间隔5 min,重复3次,共耗时30 min;早期远程缺血预适应组(80例)PCI术前2 h开始行上述方法。比较PCI术中参数及术后24 h心肌肌钙蛋白T(c TNT)、肌酸激酶同工酶(CK-MB)、高敏C反应蛋白(hs-CRP)水平及12个月不良事件发生率。结果所有患者均顺利完成PCI,术中无心肺复苏、电除颤、心源性休克等情况发生。晚期远程缺血预适应组术中胸痛[2.50%(2/80)比8.75%(7/80),P=0.018]、术中心律失常[0(0/80)比5.00%(4/80),P<0.001]、术后即刻TIMI血流≤Ⅱ级[1.25%(1/80)比6.25%(5/80),P=0.024]发生率均显著低于早期远程缺血预适应组,差异均有统计学意义。晚期远程缺血预适应组术后24 h cTnT[(11.52±2.41)pg/ml比(27.53±4.78)pg/ml,P=0.021]、CK-MB[(14.11±2.87)pg/ml比(30.23±5.17)pg/ml,P=0.032]均较早期远程缺血预适应组下降,差异均有统计学意义。两组术后24 h hs-CRP比较,差异无统计学意义(P=0.742)。K-M生存曲线显示,晚期远程缺血预适应组较早期远程缺血预适应组终点事件发生率明显下降(3.75%比13.75%),经Breslow检验P=0.024,提示两组生存率差异有统计学意义。结论晚期远程缺血预适应比早期远程缺血预适应对不稳定型心绞痛PCI术患者有更强大的心肌保护作用,并改善患者术后12个月预后。
Objective To investigate the different effects of early and late remote ischemic preconditioning on patients with unstable angina percutaneous coronary intervention (PCI). Methods A total of 160 patients with unstable angina pectoris undergoing elective PCI at Yuebei Peoples Hospital from January 2014 to January 2016 were enrolled. Among them, 80 patients with advanced remote ischemic preconditioning group (80 patients) Ischemic preconditioning, cuff pressure with sphygmomanometer brachial artery. The sphygmomanometer was pressurized to 200 mmHg (1 mmHg = 0.133 kPa) for 5 min and then deflated for 5 min at 3 min intervals for a total of 30 min. In the early ischemic preconditioning group (80 patients) 2 h before PCI began the above method. The parameters of PCI and the levels of cTnT, CK-MB, hs-CRP and incidence of adverse events at 12 months after PCI were compared . Results All patients underwent PCI successfully without cardiopulmonary resuscitation, defibrillation and cardiogenic shock. The rate of chest pain in patients with advanced remote ischemic preconditioning was 2.50% (2/80) vs 8.75% (7/80) (P = 0.018), arrhythmia at 0 (0/80) to 5.00% (4/80) ), P <0.001]. The incidence of TIMI blood flow ≤ grade Ⅱ [1.25% (1/80) vs 6.25% (5/80), P = 0.024] immediately after operation was significantly lower than that of the early remote ischemic preconditioning group , The differences were statistically significant. The ratio of cTnT [(11.52 ± 2.41) pg / ml (27.53 ± 4.78) pg / ml, P = 0.021] and CK-MB [(14.11 ± 2.87) pg / ml) in the remote ischemic preconditioning group 30.23 ± 5.17) pg / ml, P = 0.032] than the early remote ischemic preconditioning group decreased, the differences were statistically significant. There was no significant difference in hs-CRP between the two groups at 24 h (P = 0.742). KM survival curves showed that the incidence of end-point events in remote ischemic preconditioning group was significantly lower than that of the early remote ischemic preconditioning group (3.75% vs. 13.75%), and Breslow test showed P = 0.024, indicating statistically significant difference between the two groups significance. Conclusions Long-term remote ischemic preconditioning has a stronger myocardial protective effect on patients with unstable angina pectoris than early remote ischemic preconditioning and improves prognosis at 12 months after operation.