吗啡联合渐进缺血后适应对ST段抬高型急性心肌梗死的心脏保护观察

刘磊; 吴冰颖; 莫雁飞; 朱建中; 王俊锋; 顾明; 许浩军; 于宗良

doi:10.13201/j.issn.1001-1439.2019.08.008

吗啡联合渐进缺血后适应对ST段抬高型急性心肌梗死的心脏保护观察

- 1 江苏大学附属昆山医院心内科(江苏昆山, 215300);
- 2 郎溪县人民医院心内科
基金项目:
江苏大学医学临床科技发展 (No:JLY20160044)

详细信息

通讯作者: 于宗良, E-mail:zongliang-yu@163.com

中图分类号: R541.4

收稿日期: 2019-01-07

Cardioprotective effects of morphine combined with gradual ischemic postconditioning on patients with acute ST-segment elevation myocardial infarction

- 1 Department of Cardiology, the First People's Hospital of Kunshan Affiliated to Jiangsu University, Kunshan, Jiangsu, 215300, China;
- 2 Department of Cardiology, the People's Hospital

More Information

Corresponding author: YU Zongliang, E-mail: zongliang-yu@163.com

Received Date: 07 January 2019

摘要

摘要: 目的:探讨直接经皮冠状动脉介入术 (primary percutaneous coronary intervention, PPCI) 前使用吗啡联合术中应用渐进式缺血后适应 (ischemic postconditioning, IPostC) 对急性ST段抬高型心肌梗死 (ST-segment elevation myocardial infarction, STEMI) 患者的心脏保护作用。方法:选择行PPCI的STEMI患者124例, 按随机数字表法分为渐进IPostC组 (32例) 、吗啡组 (30例) 、吗啡联合渐进IPostC组 (30例) 和常规再灌注组 (32例) , 比较4组患者术中再灌注心律失常发生率、ST段回落幅度总和百分比 (Sum-STR) 、校正心肌梗死溶栓治疗帧数 (CTFC) 、肌酸激酶同工酶 (CK-MB) 峰值、左室射血分数 (LVEF) 及患者满意度等的变化。结果:渐进IPostC组、吗啡联合渐进IPostC组频发室性期前收缩 (室早) 发生率均明显低于常规再灌注组 (28.1%、26.7%∶56.3%, 均P<0.05) , 渐进IPostC组和吗啡联合渐进IPostC组室性心动过速 (室速) 发生率明显低于常规再灌注组 (12.5%、10.0%∶40.6%, 均P<0.05) , 吗啡组 (33.3%) 较常规再灌注组差异无统计学意义, 心室颤动、心动过缓、窦性停搏的发生率在4组间差异均无统计学意义;渐进IPostC组、吗啡联合渐进IPostC组Sum-STR、CTFC、CK-MB峰值均明显低于常规再灌注组[Sum-STR: (60.1±21.4) %、 (62.8±20.4) %∶ (45.3±20.2) %;CTFC: (22.34±7.24) 帧、 (20.91±6.33) 帧∶ (28.48±8.73) 帧;CK-MB峰值: (106.0±78.4) U/L、 (98.4±80.4) U/L∶ (135.4±75.7) U/L;均P<0.05], 且吗啡联合渐进IPostC组作用相较单独采用渐进IPostC组效果更优;渐进IPostC组、吗啡联合渐进IPostC组LVEF水平均高于常规再灌注组 (0.546±0.033、0.540±0.032∶0.525±0.036) ;联合组患者满意度最高。结论:吗啡联合渐进IPostC能更显著减轻STEMI患者PPCI术中的心肌再灌注损伤, 吗啡和渐进IPostC对心脏保护具有协同作用。
- 心肌梗死 /
- ST段抬高型 /
- 吗啡 /
- 缺血后适应 /
- 直接经皮冠状动脉介入
Abstract: Objective:To observe the protective effect of morphine combined with gradual ischemic postconditioning (IPostC) on reperfusion injury in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) .Method:A total of 124 patients with STEMI who underwent PPCI were enrolled according to the random number table:gradual IPostC group (n=32) , morphine group (n=30) , morphine combined with gradual IPostC group (n=30) and routine reperfusion group (n=32) .The changes of incidence of reperfusion arrhythmia, related lead ST segment regression (Sum-STR) , corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) , peaks of MB isoenzyme of creatine kinase (CK-MB) , left ventricular ejection fraction (LVEF) and satisfaction in the follow-up period were compared among the four groups.Result:The incidence of ventricular premature beats was significantly lower in gradual IPostC and morphine combined with gradual IPostC groups than that in routine reperfusion group (28.1%, 26.7% vs.56.3%, both P<0.05) , and the incidence of ventricular tachycardia was significantly lower in gradual IPostC and morphine combined with gradual IPostC groups than that in routine reperfusion group (12.5%, 10.0% vs.40.6%, both P<0.05) .No significant difference was found in the incidences of ventricular fibrillation, bradyarrhythmia and sinus arrest among the four groups.In gradual IPostC and morphine combined with gradual IPostC groups, the Sum-STR incidence, CTFC, CK-MB peaks were lower than those in routine reperfusion group [SumSTR: (60.1±21.4) %, (62.8±20.4) %vs. (45.3±20.2) %;CTFC:22.34±7.24, 20.91±6.33 vs.28.48±8.73;CK-MB peaks: (106.0±78.4) U/L, (98.4±80.4) U/L vs. (135.4±75.7) U/L;all P<0.05], and the effect in morphine combined with gradual IPostC group was better than that in gradual IPostC group alone.The level of LVEF was slightly higher in morphine and morphine combined with gradual IPostC groups than that in routine reperfusion group (0.546±0.033, 0.540±0.032 vs.0.525±0.036) .At last, patients in the combined group had the highest degree of satisfaction.Conclusion:Morphine combined with gradual IPostC significantly attenuate myocardial reperfusion injury during PPCI in patients with STEMI.In addition, morphine and gradual IPostC have synergistic effects on cardioprotection.
- ST-segment elevation myocardial infarction /
- morphine /
- ischemic postconditioning /
- primary percu taneous coronary intervention /

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