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缺血后处理结合PCI对急性心肌梗死患者心率震荡的保护作用
周珏珉,罗贵全,禹丽,杨雨衡
0
(遂宁市中心医院心电图室,四川 遂宁629000)
摘要:
目的 探讨使用窦性心率震荡(HRT)评价普通经皮冠状动脉介入治疗(PCI)结合缺血后处理对心肌细胞的保护作用,并揭示其保护自主神经的具体机制。方法 选择2014年1月~2016年1月在我院经冠脉造影确诊急性心肌梗死(AMI)患者1 00例,分为常规PCI组(A组)与缺血后处理组(B组)。收集术前和术后12、24、48h及7d的动态心电图并算出HRT的震荡初始(TO)及震荡斜率(TS)。所有AMI 患者分别于PCI术前,术后12、24、48h及7d抽取静脉血3~5 ml,使用ELISA法检测血清白细胞介素6 (IL-6)、白细胞介素-8 ( IL-8)、超敏C反应蛋白(hsCRP)及肿瘤坏死因子α-(TNF)含量。结果 常规组与后处理组年龄、性别、糖尿病、高血压、吸烟及总胆固醇分布差异无统计学意义( P>0. 05);后处理组与常规组比较,TO值在术后24h差异有统计学意义(P<0.05),而TS在术后24h、7d时差异均有统计学意义(P<0.05);TO术后与术前相比呈下降趋势,而TS为上升趋势; IL-6、hsCRP 、IL-8及TNFα术前与术后含量变化总体呈先增加后下降趋势。结论 PCI术中结合缺血后处理通过减少IL-6、hsCRP 、IL-8和TNFα的产生,减少自身和相互作用,从而减少其对心肌细胞和自主神经的损伤,进而起到保护心肌自主神经调节功能。
关键词:  PCI术  缺血后处理  炎症因子  自主神经
DOI:
基金项目:四川省卫计委科研课题(17PJ021)
Protective mechanisms for heart rate turbulence with acute myocardial infarction by ischemic posttreatment combined with PCI
ZHOU Juemin,LUO Guiquan,YU Li,YANG Yuheng
(Department of Electrocardiogram, Suining Central Hospital, Suning 629000, Sichuan, China)
Abstract:
Objective To explore protective effects on myocardial cell of combined with percutaneous coronary intervention (PCI) and ischemic postconditioning to heart rate turbulence (HRT) and reveal its specific mechanism with protecting autonomic nerve.Methods 100 patients with AMI in our hospital by coronary angiography from January 2014 to January 2016 were divided into regular PCI group (group A) and ischemic postconditioning group (group B). The dynamic electrocardiogram of preoperative and postoperative 12 h, 24 h, 48 h and 7 day were collected to calculate the HRT of TO and TS. ELISA was used to test the serum IL-6, IL-8, hs-CRP and TNFα. Results There were no statistically significant difference of age, gender, hypertension, diabetes, smoking, and total cholesterol in group A and group B (P>0. 05). Compared with group A, the difference was statistically significant at postoperative 24 h in Group B of TO values (P<0.05). While the difference was statistically significant at postoperative 24 h and 7 day in Group B of TS values (P< 0.05). Tendency of IL-6, hs-CRP, IL-8 and TNFα changed were increased firstly and then decreased. Conclusion During PCI operation, ischemic postconditioning protected the regulation of cardiac autonomic nervous function by reducing the IL-6, hs-CRP , IL-8 and TNFα, and reducing damage to myocardial cell and autonomic nerve.
Key words:  PCI  Ischemic postconditioning  Inflammatory factor  Autonomic nerve

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