Xu Yuansheng, Yu Qinkai, Yang Jianmin, Yuan Fang, Zhong Yigang, Zhou Zhanlin, Wang Ningfu
Department of Cardiology, The Affiliated Hangzhou Hospital of Nanjing Medical University, Hangzhou First People's Hospital, Hangzhou, 310006, China.
Acta Cardiol Sin. 2018 Jul;34(4):299-306. doi: 10.6515/ACS.201807_34(4).20180317A.
The aim of this study was to assess the acute hemodynamic effects of remote ischemic preconditioning (RIPC) on coronary perfusion pressure and coronary collateral blood flow.
A total of 17 patients with coronary heart disease with severe (70%-85%) stenosis in one or two vessels confirmed by angiography were enrolled into this study. They were randomly divided into the RIPC group (9 patients) and the control group (8 patients). Distal pressure of coronary artery stenosis before balloon dilation (non-occlusive pressure, P) and distal coronary artery occlusive pressure (P) during balloon dilation occlusion were measured in all patients. The patients in the RIPC group received three cycles of lower limb ischemia-reperfusion preconditioning (5 minutes inflation of a blood pressure cuff, followed by 5 minutes reperfusion). For controls, the cuff was not inflated. After this process, P and P were measured again in each patient.
There were no significant differences in angiographic characteristics between the two groups (all p > 0.05). Troponin I (TNI) levels after percutaneous coronary intervention (PCI) were lower in the RIPC group than in the control group (p = 0.004). In the RIPC group, mean P and P were significantly increased after RIPC compared to before RIPC [(72.78 ± 10.10) mmHg vs. (79.67 ± 9.79) mmHg, p = 0.002, (20.89 ± 8.61) mmHg vs. (26.78 ± 10.73) mmHg, p = 0.001, respectively].
RIPC can improve distal coronary perfusion pressure and rapidly increase distal coronary occlusive pressure thereby improving coronary collateral blood flow.
本研究旨在评估远程缺血预处理（RIPC）对冠状动脉灌注压和冠状动脉侧支血流的急性血流动力学影响。
共纳入17例经血管造影证实单支或双支血管严重（70%-85%）狭窄的冠心病患者。他们被随机分为RIPC组（9例患者）和对照组（8例患者）。测量所有患者球囊扩张前冠状动脉狭窄远端压力（非闭塞压力，P）和球囊扩张闭塞期间冠状动脉远端闭塞压力（P）。RIPC组患者接受三个周期的下肢缺血-再灌注预处理（血压袖带充气5分钟，随后再灌注5分钟）。对于对照组，袖带不充气。此过程后，再次测量每位患者的P和P。
两组血管造影特征无显著差异（所有p>0.05）。经皮冠状动脉介入治疗（PCI）后，RIPC组肌钙蛋白I（TNI）水平低于对照组（p=0.004）。在RIPC组中，与RIPC前相比，RIPC后平均P和P显著升高[分别为(72.78±10.10)mmHg对(79.67±9.79)mmHg，p=0.002，(20.89±8.61)mmHg对(26.78±10.73)mmHg，p=0.001]。
RIPC可改善冠状动脉远端灌注压并迅速增加冠状动脉远端闭塞压力，从而改善冠状动脉侧支血流。
