增强型体外反搏联合远端缺血预处理对冠心病患者内皮功能的影响

发布时间：2018-05-31 13:46

本文选题：增强型体外反搏 + 远端缺血预处理　；参考：《河北医科大学》2016年硕士论文

【摘要】：目的:探讨增强型体外反搏(EECP)、远端缺血预处理(RIPC)及两者联合对冠心病患者内皮功能的影响。方法:选择2015年3月至2015年12月在我院康复科门诊就医的冠心病患者80例,将其随机分为对照组20例,EECP组20例,RIPC组20例及联合组20例,所有患者均接受常规药物治疗(抗血小板、硝酸酯类、钙拮抗剂、β受体阻滞剂等)。其中,EECP组患者每日给予增强型体外反搏治疗(50min,2次/日,连续18天),RIPC组患者每日行左上肢缺血预处理治疗(充气5min*放气5min,5个循环,1次/日,连续18天),联合组每日给予增强型体外反搏+左上肢缺血预处理治疗(50min,2次EECP+1次RIPC/日,连续18天),所有受试者分别与治疗前、后测定血浆NO2-/NO3-、ET-1及血清IL-6、TNF-a水平。结果:(1)EECP组、RIPC组及联合组患者治疗后血浆NO2-/NO3-水平均高于对照组水平[(99.42±9.32)、(89.78±6.39)、(97.62±10.33)vs(80.65±8.66)umol/L,P0.05],其中EECP组与联合组血浆NO2-/NO3-水平均高于RIPC组[(99.42±9.32)、(97.62±10.33)vs(89.78±6.39)umol/L,P0.05]但这两者之间差异无统计学意义[(99.42±9.32)vs(97.62±10.33)umol/L,P0.05](2)EECP组、RIPC组及联合组患者治疗后血浆ET-1及均低于对照组水平[(109.58±14.41)、(147.47±34.27)、(112.15±15.43)vs(175.63±34.93)ng/L,P0.05],其中EECP组与联合组血浆ET-1水平均低于RIPC组[(109.58±14.41)、(112.15±15.43)vs(147.47±34.27)ng/L,P0.05],但这两组之间差异无统计学意义[(109.58±14.41)vs(112.15±15.43)ng/L,P0.05];(3)EECP组、RIPC组及联合组患者治疗后血清IL-6水平均低于对照组水平[(12.05±1.78)、(15.11±2.64)、(13.04±1.34)vs(18.65±2.65)ng/L,P0.05],其中EECP组与联合组血浆IL-6水平均低于RIPC组[(12.05±1.78)、(13.04±1.34)vs(15.11±2.64)ng/L,P0.05],但这两组之间差异无统计学意义[(12.05±1.78)vs(13.04±1.34)ng/L,P0.05];(4)EECP组、RIPC组及联合组患者治疗后血清TNF-a水平均低于对照组水平[(316.97±24.25)、(361.85±52.38)、(322.83±44.43)s(406.90±44.12)ng/L,P0.05],其中EECP组与联合组血清TNF-a水平均低于RIPC组[(316.97±24.25)、(322.83±44.43)vs(361.85±52.38)ng/L,P0.05],但这两组之间差异无统计学意义[(316.97±24.25)vs(322.83±44.43)ng/L,P0.05]。结论:增强型体外反搏及远端缺血预处理均可减轻机体炎症水平,改善冠心病患者内皮功能,但两者联合效果并不比单纯增强型体外反搏强。
[Abstract]:Objective: To investigate the effect of enhanced extracorporeal counterpulsation (EECP), distal ischemic preconditioning (RIPC) and both on the endothelial function of patients with coronary heart disease. Methods: 80 cases of coronary heart disease were selected from March 2015 to December 2015 in our hospital, and were randomly divided into 20 cases, 20 cases in group EECP, 20 cases in group RIPC and 20 cases in combination group. The patients received conventional medication (antiplatelet, nitrates, calcium antagonist, beta blocker, etc.). In group EECP, patients were given enhanced external counterpulsation (50min, 2 / day, 18 days), and group RIPC patients were treated daily with left upper limb ischemic preconditioning treatment (inflatable 5min* release 5min, 5 circulation, 1 / day, 18 consecutive days), combined for 18 days. The group was treated with enhanced external counterpulsation and left upper limb ischemic preconditioning (50min, 2 times EECP+1 RIPC/ day, 18 days for consecutive days). All the subjects measured plasma NO2-/NO3-, ET-1 and serum IL-6, TNF-a levels before and after treatment. Results: (1) the level of NO2-/NO3- in the group of EECP, RIPC group and combined group was higher than that of the control group [99 .42 + 9.32), (89.78 + 6.39), (97.62 + 10.33) vs (80.65 + 8.66) umol/L, P0.05], and the level of plasma NO2-/NO3- in group EECP and combined group was higher than that in group RIPC [(99.42 + 9.32), (97.62 + 10.33) vs (89.78 + 6.39) umol/L, P0.05] but there was no statistical significance [(99.42 +] vs) umol/L After treatment, the plasma ET-1 was lower than that of the control group [(109.58 + 14.41), (147.47 + 34.27), (112.15 + 15.43) vs (175.63 + 34.93) ng/L, P0.05], and the level of plasma ET-1 in EECP group and combined group was lower than that in group RIPC [109.58 + 14.41), (112.15 + 15.43) vs (147.47 +%) ng/L, P0.05], but there was no significant difference between these groups 8 + 14.41) vs (112.15 + 15.43) ng/L, P0.05]; (3) EECP group, RIPC group and combined group after treatment, the mean serum IL-6 water was lower than that of the control group [12.05 + 1.78), (15.11 + 2.64), (13.04 + 2.64) vs (18.65 + 2.65) ng/L, P0.05], among which the EECP group and the combined group plasma IL-6 water were lower than that of the RIPC group. .05], but there was no significant difference between the two groups [(12.05 + 1.78) vs (13.04 + 1.34) ng/L, P0.05]; (4) the serum TNF-a level in EECP group, RIPC group and combined group was lower than that of the control group [316.97 + 24.25), (361.85 + 52.38), (322.83 + 44.43) s (406.90 + 44.12) ng/L, P0.05], and EECP group was lower than that of the combined group. In group RIPC [(316.97 + 24.25), (322.83 + 44.43) vs (361.85 + 52.38) ng/L, P0.05], there was no significant difference between these two groups [(316.97 + 24.25) vs (322.83 + 44.43) ng/L, P0.05]. conclusion: enhanced extracorporeal counterpulsation and distal ischemic preconditioning could reduce the level of inflammation in the body and improve endothelial function in patients with coronary heart disease, but the combined effect of the two groups was combined. No stronger counterpulsation than a simple enhanced type of counterpulsation.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.4

【参考文献】