心肌缺血再灌注损伤不同表现形式的临床研究

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摘要目的探讨心肌缺血再灌注损伤不同表现形式的危险因素及预后。方法选取2015年1～11月于承德医学院附属医院行直接经皮冠状动脉介入治疗的患者91例，根据发生缺血再灌注损伤的不同临床表现形式进行分组，缓慢性心律失常组21例，对照1组70例；快速性心律失常组9例，对照2组82例；再灌注低血压组28例，对照3组63例。记录病史、诊断、手术及治疗方案，进行随访并完成汇总。结果缓慢性心律失常组罪犯血管为右冠状动脉、侧支循环发生率高于对照1组，罪犯血管为左冠状动脉前降支发生率低于对照1组，差异有统计学意义（P ＜ 0.05）。快速性心律失常组症状-就诊时间早于对照2组，罪犯血管为右冠状动脉发生率高于对照2组，差异有统计学意义（P ＜ 0.05）。再灌注低血压组罪犯血管为左冠状动脉前降支发生率、射血分数、入院24 h β受体阻滞剂及入院24 h 血管紧张素转化酶抑制剂/血管紧张素受体拮抗剂低于对照3组，罪犯血管为右冠状动脉发生率及总胆固醇水平高于对照3组，差异有统计学意义（P ＜ 0.05）。根据术后随访结果绘制生存曲线，经Log Rank检验得出不同临床表现形式分组患者Kaplan-Meier生存曲线，差异均无统计学意义（P ＞ 0.05）。结论罪犯血管为右冠状动脉是发生缺血再灌注损伤的危险因素。存在侧支循环对预测发生缓慢性心律失常、症状-就诊时间短对预测发生快速性心律失常、总胆固醇水平高对预测发生低血压具有重要意义。

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	张英王亚柱张皓然刘超张爱文孙王乐贤丁振江

关键词 ：冠状动脉介入治疗, 缺血再灌注损伤, 缓慢性心律失常, 快速性心律失常, 再灌注低血压

Abstract：Objective To explore the risk factors and prognosis of different manifestations of myocardial ischemia-reperfusion injury. Methods Ninety-one patients who underwent direct percutaneous coronary intervention in Affiliated Hospital of Chengde Medical College from January to November 2015 were divided into groups according to different clinical manifestations of ischemia-reperfusion injury. Twenty-one cases in bradyarrhythmia group and 70 cases in control group 1; 9 cases in tachyarrhythmia group and 82 cases in control group 2; 28 cases in reperfusion hypotension group and 63 cases in control group 3. Medical history, diagnosis, operation and treatment plan, follow-up and summary were recorded. Results The incidence of right coronary artery and collateral circulation of criminals in bradyarrhythmia group was higher than that in control group 1, the incidence of left anterior descending coronary artery of criminals in bradyarrhythmia group was lower than that in control group 1, the differences were statistical significance (P < 0.05). The symptoms-visiting time of tachyarrhythmia group was earlier than that of control group 2, and the incidence of right coronary artery was higher in criminals than that of control group 2, the differences were statistical significance(P < 0.05). The incidence of anterior descending branch of left coronary artery, ejection fraction, 24 h β receptor blocker and 24 h ACEI/ARB of criminals in reperfusion hypotension group were lower than those in control group 3, while the incidence of right coronary artery and total cholesterol level of criminals in reperfusion hypotension group were higher than those in control group 3, the differences were statistical significance (P < 0.05). The survival curves were drawn according to the follow-up results. The Kaplan-Meier survival curves of patients with different clinical manifestations were obtained by Log Rank test, there was no significant difference (P > 0.05). Conclusion The criminals′ right coronary artery is a risk factor for ischemia-reperfusion injury. The presence of collateral circulation is of great significance in predicting bradyarrhythmia, short symptom-visit time, rapid arrhythmia and high total cholesterol level.

Key words： Percutaneous coronary intervention Ischemia reperfusion injure Bradyarrhythmia Tachyarrhythmia Reperfusion hypotension

基金资助:河北省医学科学研究重点课题计划（20160016）。

引用本文:

张英王亚柱张皓然刘超张爱文孙王乐贤丁振江. 心肌缺血再灌注损伤不同表现形式的临床研究[J]. 中国医药导报, 2019, 16(23): 64-68.
ZHANG Ying WANG Yazhu ZHANG Haoran LIU Chao ZHANG Aiwen SUN WANG Lexian DING Zhenjiang. Clinical study on different manifestations of myocardial ischemia-reperfusion injury. 中国医药导报, 2019, 16(23): 64-68.

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