远隔器官后适应联合依达拉奉对急性心肌梗死患者心肌缺血再灌注损伤作用的研究

来源 :重庆医科大学学报 | 被引量 : 0次 | 上传用户:lzyrock
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目的:探讨远隔器官后适应联合应用依达拉奉对急性心肌梗死患者心肌缺血再灌注损伤的作用。方法:选取2013年01月至2014年12月我院收治的急性心肌梗死患者144例,随机分为I/R组(静脉溶栓治疗)、RPOC组(静脉溶栓治疗+远隔器官后适应治疗)、E组(静脉溶栓+依达拉奉注射液静脉点滴)、ER组(静脉溶栓+远隔器官后适应+依达拉奉注射液静脉点滴),每组36例,分析各组患者肌酸激酶同工酶(creatine kinase isoenzymes,CKm B)及肌钙蛋白(cardiac troponinⅠ,c Tn I)分泌峰值及其动态变化,同时比较各组患者溶栓治疗后超声心动图指标,治疗后进行随访,观察不良事件发生情况。结果:CKm B、c Tn I峰值在I/R组、E组、RPOC组、ER组患者中依次降低,组间差异均具有统计学意义(P<0.05);与I/R组比较,E组、EROC组、ER组患者左室舒张末内径(left ventricular enddiastolic,LVED)、计算室壁节段运动指数(wall motion score index,WMSI)均明显降低,左室射血分数(left ventricular ejection fractions,LVEF)%明显升高(P<0.05);ER组患者LVED、WMSI均明显低于E组和RPOC组(P<0.05),LVEF%明显高于E组和RPOC组(P<0.05),WMSI明显低于E组(P<0.05),但与RPOC组比较差异无统计学意义(P>0.05);4组患者治疗后均随访3个月,随访期间均无失访和死亡病例,E组、EROC组、ER组再梗死、脑卒中、梗死后心绞痛、心力衰竭等不良事件发生率均明显低于I/R组(P<0.05),但3组间比较,差异无统计学意义(P>0.05)。结论:远隔器官后适应及依达拉奉的应用都能显著减少CKm B和c Tn I的释放,减轻急性心肌梗死后心室重塑,改善室壁运动,从而减轻心肌再灌注的损伤,改善预后。 OBJECTIVE: To investigate the effect of adjuvant remote organ application with edaravone on myocardial ischemia-reperfusion injury in patients with acute myocardial infarction. Methods: A total of 144 acute myocardial infarction patients admitted to our hospital from January 2013 to December 2014 were randomly divided into I / R group (intravenous thrombolytic therapy), RPOC group (intravenous thrombolysis + distal organ adaptation Group E (intravenous thrombolysis + edaravone injection intravenous drip), ER group (intravenous thrombolysis + remote organ adaptation + edaravone injection intravenous drip), 36 cases in each group were analyzed The peak value and its dynamic changes of creatine kinase isoenzymes (CKm B) and cardiac troponin I (c Tn I) in patients were compared. Echocardiographic parameters after thrombolysis were compared between the two groups After follow-up, observe the occurrence of adverse events. Results: The peak values ​​of CKm B and c Tn I were decreased in I / R group, E group, RPOC group and ER group, the differences were statistically significant (P <0.05). Compared with I / R group, E Left ventricular end-diastolic diameter (LVED) and wall motion score index (WMSI) were significantly decreased in the EROC group, ER group and ER group. The left ventricular ejection fraction (left ventricular ejection fraction) (P <0.05). The LVED and WMSI in ER group were significantly lower than those in E group and RPOC group (P <0.05), LVEF% was significantly higher than that in E group and RPOC group (P <0.05) WMSI was significantly lower than that of E group (P <0.05), but there was no significant difference with RPOC group (P> 0.05); 4 groups of patients were followed up for 3 months after treatment, with no follow-up and death cases during follow-up The incidence of adverse events such as re-infarction, stroke, post-infarction angina pectoris and heart failure in the EROC and ER groups were significantly lower than those in the I / R group (P <0.05), but there was no significant difference among the three groups P> 0.05). CONCLUSION: Post-far-organ conditioning and edaravone can significantly reduce the release of CKm B and cTn I, reduce ventricular remodeling after acute myocardial infarction and improve ventricular wall motion, thus reducing myocardial reperfusion injury and improving Prognosis.
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