| Background: Percutaneous coronary intervention(PCI)is one of the most common revascularization methods for patients with coronary heart disease(CHD),but the reperfusion process can easily cause myocardial ischemia reperfusion injury(MIRI),causing a series of adverse consequences,seriously endangering the prognosis of patients.Seeking a solution to reperfusion injury has become the most concerned topic in recent years.Remote ischemic preconditioning(RIPC),as a powerful endogenous protection method,can protect the myocardium from reperfusion injury.Most animal experiments can confirm this theory by studying its intrinsic protective mechanism,and the protective effect of RIPC still has value for exploration.At present,the research on RIPC for CHD patients in clinical trials mainly focuses on the upper limbs to perform RIPC operations,and there are few researches on the experimental design of lower limb RIPC.Objective: To evaluate the myocardial protective effect of lower limb RIPC on CHD patients undergoing elective PCI,and to provide a reference for the clinical application of lower limb RIPC in the prevention and treatment of MIRI.Methods: The subjects of the study were 98 CHD patients who underwent elective PCI in the Department of Cardiology,Yanbian University Affiliated Hospital from September 2020 to October2020.Qualified patients were randomly divided into RIPC group(n=40)and control group(n=40).RIPC patients were bound to the right lower limb with a blood pressure band of remote ischemia preconditioning instrument and pressurized to 200 mm Hg(1mm Hg= 0.133 k Pa)for decompression and blood flow recovery for 5min after the lower limb was occluded for 5min within 2h before PCI,and repeated 4 times for a total of 40 min.A similar tourniquet was placed around the lower extremities in the control group,but without inflatable compression.RIPC group was performed right lower extremity RIPC 2h before PCI.Cardiac troponin I(c Tn I),creatine kinase(CK),creatine kinase MB(CK-MB),and high-sensitive C-reactive protein(hs-CRP)levels were compared before and 24 h after PCI.The effect of RIPC on the prognosis of patients after PCI was evaluated by evaluating major advers cardiac events(MACE)during hospitalization and following up.Results:1.Comparison of the general clinical data of the two groups of patients: the RIPC group and the control group in terms of age,gender,smoking history,history of hypertension and diabetes,blood lipids,body mass index(BMI),and left ventricular ejection fraction(LVEF),CCS classification of angina,hemoglobin,albumin,creatinine,urea nitrogen and drug use(P>0.05).2.Comparison of intraoperative data of PCI between the two groups: there were no statistical differences between the RIPC group and the control group in the changes of coronary artery lesion vessels,lesion complexity,balloon dilation time and times,average diameter,length and number of stent implantation,intraoperative blood pressure and heart rate(P>0.05).The incidence of intraoperative chest discomfort in RIPC group was lower than that in control group,and the difference was statistically significant(P<0.05).3.Comparison of biochemical examination results before and 24 h after PCI: there were no statistical differences in the test results of c Tn I,CK,CK-MB and hs-CRP before PCI between the two groups(P>0.05).The increase level of c Tn I in RIPC group was lower than that in control group(P<0.05),and the difference was statistically significant.There were no statistical differences in CK,CK-MB and hs-CRP between the two groups after operation(P>0.05).4.After discharge,patients were followed up for 6 months: the incidence of MACE events in the RIPC group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion:Lower limb RIPC can reduce the occurrence of myocardial injury and intraoperative chest pain in patients with elective PCI,and can improve the 6-month prognosis of patients with elective PCI. |
PDF Full Text Request