新活素治疗急诊PCI术后急性前壁心肌梗死患者的临床观察

Clinical observation of Xinhuosu in the treatment for patients of acute anterior myocardial infarction after primary PCI

关键词:  新活素  急性心肌梗死  经皮冠状动脉介入治疗

Key words:  [Key words]　Xinhuosu  acute myocardial infarction  percutaneous coronary intervention

摘要:

目的　探讨新活素治疗急诊PCI术后BNP水平较高的急性前壁心肌梗死患者的疗效和安全性。　方法　　将大连医科大学附属第一医院2011年8月—2012年8月收治的128 例急性前壁ST段抬高性心肌梗死患者随机分为对照组（64例）和新活素组（64例）。对照组患者给予抗凝、抗血小板、他汀类、β受体阻滞剂、硝酸酯类药物和血管紧张素转化酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)及利尿剂等常规治疗，新活素组患者在常规治疗的基础上加用新活素（1~2 min 内匀速静脉注射负荷量1.5 μg/kg，然后以0.01 μg/(kg·min) 静脉匀速泵入持续72 h）。随访6个月，观察各组患者的疗效和安全性。　结果　　与对照组比较，新活素组住院期间急性左心衰发生率（心功能≥Killip3级）较低(9.38% vs 21.88%，P<0.05)，随访6个月时BNP较低(98.7±41.2 vs 465.4±46.8,P<0.05)、 6 min步行距离较长[(576.0±82.5)m vs (494.0±74.1)m,P<0.05]、左室舒张末径较小[(50.5±3.8)mm vs( 59.3±4.1)mm, P<0.05]，左室射血分数较高[(54.7±16.9)% vs (46.2±18.6)%, P<0.05]，而住院期间严重低血压（＜90/60 mmHg）的发生率两组相当。　结论　　新活素治疗能显著改善急诊PCI术后BNP水平较高的急性前壁ST段抬高性心肌梗死患者的心功能。

Abstract:

[Abstract] Objective　To observe the clinical efficacy and safety of Xinhuosu for patients of acute anterior myocardial infarction with BNP level higher after successful primary percutaneous coronary intervention ( PCI ). 　Methods　128 patients with acute anterior ST-elevation myocardial infarction had all undergone successful primary PCI. Patients were randomly assigned to 2 groups (control and Xinhuosu groups), and given Xinhuosu or saline after PCI besides conventional therapy. All the patients were followed up for 6 months. The clinical efficacy and safety of both groups were observed. 　Results　In the Xinhuosu group, the rate of acute left heart failure during the hospital stay was lower (9.38% vs 21.88%，P<0.05), and after follow-up of 6 months, BNP was lower (98.7±41.2 vs 465.4 ±46.8, P<0.05)，Walking distance for 6 minutes was longer, (576±82.5) m vs (494±74.1) m, P<0.05, Left ventricular end-diastolic diameter (LVEDD) was lower,(50.5±3.8) mm vs (59.3±4.1) mm, P<0.05, Left ventricular ejection fraction (LVEF) was higher,(54.7±16.9)% vs (46.2±18.6)%, P<0.05, while severe hypotension (＜90/60 mm Hg) during the hospital stay was not higher (46.9% vs 39.1%, P>0.05), comparing with those in control group. 　Conclusion 　Xinhuosu can greatly improve the cardiac function of the patients of acute anterior myocardial infarction with BNP level higher after primary PCI.