| ObjectiveTo explore and find the myocardial effects and possible mechanisms of long-term remote limb ischemic postadaptation after primary percutaneous coronary intervention(PCI)in patients with acute ST-segement elevation myocardial infarction.MethodsPart one clinical experiment:101 patients diagnosed with acute ST-segement elevation myocardial infarction in Liaocheng Hosptial and undergone primary percutaneous coronary intervention from Jan 2016 to Sep 2017 were be elected and randomized into routine PCI group and long-term remote limb ischemic postadaptation group.The first group didn't has any special treatment,while the second group was treated by long-term remote limb ischemic postconditioning,which happened in the medical ward immediately after primary PCI operation.Pressure cuff was fastened to the unradialed artery upper limb which was inflated to block for 5minutes and was deflated to reperfuse for 5minutes.The process was repeated 4times,lasted for 40 minutes,which was done in every morning and afternoon for 3 days and be done by double limbs for 2weeks in all.All patients were given aspirin 300 mg and ticagrelor 180 mg at the mount of load.The experiment program was acquired informed content by the patients' family members before the operation,and was approved by the hospital ethics committee.The postoperative treatment plan was carried out according to the guidelines for the treatment of acute myocardial infarction.The levels of TNI and CKMB were detected by Chemiluminescence in all patients at preoperation of PCI,at 12 hours,24 hours,48 hours,and 72 hours after PCI operation.Rate of ST segment resolution greater than equal to or equal to 70% at 1h post-operation was measured by ECG,new arrhythmia at 24 hours after PCI operation was recorded,blood urea nitrogen and creatinine were measured before and after the operation,and left ventricular fraction and the wall motion score index were measured by pre and post the operation.Part two clinical experiment: The experiment operation process was in the same with part one.The levels of superoxide dismutase(SOD)and high sensitive C reactive protein(hsCRP)were measured by automiatic biochemical analyzer,malondialdehyde was measured by colorimetry,and SDF-1 was measured by enzyme linked immunosorbent assay.Results(1)Compared with the routine PCI group,the level of TNI and CKMB in the group of long-term remote limb ischemic postadaptation had a different degrees of decrease at the different times in 12,24,and 48 hous after the operation(P<0.01 or P<0.05),while it had no obvious differernce at the time of 72 h post-PCI operation between the two groups(P> 0.05).There had no different at the time of 72 hours after the operation for the level of TNI and CKMB compared with preoperation in the same group(P>0.05).Urea nitrogen and creatitine level in the long remote limb ischemic postadaptation group was significantly lower than those in the the routine PCI group(P<0.05).(2)Rate of ST segment resolution after 1 hour post-PCI operation had a certain degree of rise(P<0.05),the rate of new arrhythmia at 24 hours after PCI operation declined(P<0.05)and the cardiac function improved in the group of long-term remote ischemic postadaptation compared with the routine PCI group,the difference was statistically(P<0.05).(3)The levels of hsCRP,MDA declined and the levels of SOD,SDF-1 increased to a extent at the different times in the group of long-term remote ischemic postadaptation compared with routine PCI group,the difference was statistically significant(P<0.05 or P<0.01).ConclusionFor the patients who be cured with the primary PCI,the long-term remote limb ischemic postadaptation can play a protective role in myocardial injury.It could be shown in improving the level of postoperative CKMB,TNI,arrhythmia,myocardial function and other clinical indicators to produce myocardial protection,viaing the mechanism of oxidative stress,inflammatory reaction mechanism and vascular injury repair to work together. |
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