| Objictive: Through the inervention of local ischemic postconditioning(LIPostC)in patients with acute ST-segment elevation myocardial infarction(STEMI)who underwent primary percutaneous coronary intervention(PCI),and to observed patients plasma malondialdehyde(MDA)and superoxide dismutase(SOD)concentration,electrocardiogram rate of ST segment resolution,left ventricular ejection fraction,the quality of life,and major adverse cardiovascular endpoint events(MACE)(malignant arrhythmia,heart failure,cardiac shock,recurrence of angina,due to various reasons such as chest pain and rehospitalization,etc.)change,explore local ischemic postconditioning ischemia in patients with STEMI myocardial effects and its possible mechanism.Methods: Patients admitted to the department of cardiology of Changsha Central Hospital for STEMI from May 01,2018 to October 31,2018 were selected,patients who met the research criteria were randomly divided into treatment group and control group.Patients in control group received routine PCI treatment,while patients in treatment group received LIPostC intervention measures before routine PCI treatment.According to the different intervention time,patients in treatment group were randomly divided into 60 S group and 45 S group(LIPostC intervention time was 60 seconds and 45 seconds respectively).The changes of plasma MDA and SOD concentration at 0h,24 h and 48 h before and after treatment were detected by biochemical method.electrocardiogram rate of ST segment resolution 1h after treatment was recorded and the quality of life score was rated using SF-36 and MIDAS scales observed and the changes of LVEF,incidence of MACE tracked at 1week,4 weeks,3 months and 6 months after treatment.Results:1.A total of 216 STEMI patients were admitted during the study period,63 of them met the criteria for admission,including 21 cases in the control group(21 males and 0 females);21 cases in the 60 S group(17 males and 4 females);and 21 cases in the 45 S group(15 males and 6 females).2.There were no significant differences in baseline information age,sex,body mass index,diabetes,hypertension,family history of coronary heart disease,smoking history,blood lipid,blood glucose,plasma Carfiac troponin I(cTnI),Creatine Kinase Isoenzyme(CKMB),C-reactive protein(CRP),Brain natriuretic peptide,(BNP)concentration before treatment,chest pain and reperfusion time,coronary angiography and PCI,PCI postoperative medication(ACEI/ARB,aspirin,beta blockers,calcium channel blockers,clopidogrel,or ticagrelor),hospitalization days and so on among three groups(all P>0.05).3.The plasma MDA concentrations in three groups before treatment,at 0h,24 h and 48 h after treatment:the control group were 2.78±0.72,4.54±0.65,3.67±0.70 and3.18±0.71nnoml/L;60S group were 2.85±0.47,1.81±0.50,1.16±0.33 and0.50±0.20nnoml/L;45S group were 2.80±0.49,1.91±0.61,1.38±0.50 and0.60±0.39nnoml/L.There were no significant differences between the three groups in plasma MDA concentration before treatment(all P>0.05).The concentration of MDA in control group,60 S group and 45 S group decreased gradually and time dependent after treatment compared with that before treatment(all P<0.05).Compared with the control group,the plasma concentration of MDA in 60 S group and 45 S group all decreased significantly(all P<0.05),but there was no significant difference the plasma concentration of MDA between 60 S group and 45 S group(all P>0.05).4.The plasma SOD concentrations in three groups before treatment,at 0h,24h and 48 h after treatment:the control group were 53.22±2.97,43.89±8.70,50.46±8.02 and 54.46±7.02U/L;60S group were 55.58±3.38,73.60±9.48U/L,81.87±9.53 and 89.40±12.18U/L;45S group were 54.24±3.56,61.30±4.52U/L,64.70±5.40 and 68.43±4.97U/L.There were no significant differences between the three groups in plasma SOD concentration before treatment(all P>0.05).The concentration of SOD in control group,60 S group and 45 S group increased gradually and time dependent after treatment compared with that before treatment (all P<0.05).Compared with the control group,the plasma concentration of SOD in 60 S group and 45 S group all increased significantly(all P<0.05),compared with the 45 S group,the plasma concentration of SOD in 60 S group was increased significantly(all P>0.05).5.In 60 S group,45 S group and control group,the rate of ST segment resolution was 86%,81% and 52%,there was no significant differences(all P>0.05).6.The patients were after treatment 1 weeks,4 weeks,3 months and 6 months LVEF of the control group was 56.25±9.72,53.00±10.32,52.47±8.25 and53.43±8.48%;the 60 S group was 56.50±8.03,59.13±10.063,59.50±8.43 and63.79±7.60%;the 45 S group was 53.00±9.65,57.11±10.40,54.93±9.64 and57.56±9.58%.There were no significant differences in 1 weeks and 4 weeks after treaded LVEF among the three groups(all P>0.05),but after treaded 6 months showed higher LVEF(all P<0.05).60 S group was compared with 45 S group,patients in the60 S group in 1 weeks and 4 weeks and 3 months after PCI had no significant difference(all P>0.05),in 6 months after treatment showed a higher LVEF than in 45 S group(P<0.05).7.Compared with the control group,the quality of life SF-36 scales physical health score in 60 S group and 45 S group 6 months after treatment all increased significantly(335.50±43.47,346.87±37.64 vs.252.41 ± 43.07,all P<0.05),and mental health score all increased significantly(310.50 ± 36.07,332.70±24.69 vs.288.27±32.62,all P<0.05).Compared with the control group,the quality of life7.MIDAS scale score in 60 S group and 45 S group 6 months after treatment all decreased significantly(41.53±13.12,38.58±2.46 vs.59.31±11.91,all P<0.05).8.Compared with the control group,the incidence of MACE in 60 S group and45 S group 1 weeks,4 weeks and 3 months after treatment had no significant difference(1,1 vs.2,3 vs.6,2,1 vs.6,all P>0.05).Compared with the control group,the incidence of MACE in 60 S group and 45 S group decreased significantly(all P<0.05).but there was no significant difference between 60 S group and 45 S group(P>0.05).Conclusions:1.Patients with STEMI who are treated with local ischemic postconditioning before PCI can further improve their cardiac function,quality of life and prognosis.2.Local ischemic postconditioning may play a myocardial protection role byalleviating oxidative stress injury.3.Local ischemic postconditioning ischemia reperfusion time of 60 seconds was better than that of 45 seconds in alleviating oxidative stress injury and improving cardiac function. |
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