电针内关联合右美托咪啶治疗AMI急诊PCI患者的疗效及其对血清NT-proBNP等的影响

Therapeutic effect of electrical acupuncture at Neiguan combined dexmedetomidine on AMI patients undergoing emergency PCI and its influence on serum levels of NT-proBNP etc.

目的:研究电针内关联合右美托咪啶对急性心肌梗死(AMI)急诊PCI患者的疗效及其对血清N基末端前脑钠肽(NT-proBNP)、肿瘤坏死因子(TNF)-α、内皮素(ET)水平的影响。方法:2016年8月~2017年8月于我院治疗的AMI急诊PCI患者96例被随机均分为右美托咪啶组(在常规治疗基础上加用右美托咪啶)与联合治疗组(在右美托咪啶组基础上加用电针内关),两组均治疗5d。观察比较两组治疗前后心功能指标:左室舒张末期内径(LVEDd)、左室收缩末期内径(LVESd)、LVEF,血清心肌肌钙蛋白I(cTnI)、肌红蛋白(Mb)、肌酸激酶同工酶(CK-MB)、心脏型脂肪酸结合蛋白(H-FABP)、NT-proBNP、TNF-α、ET水平,以及不良心血管事件发生率。结果:与右美托咪啶组比较,联合治疗组治疗后LVEDd[(51.32±5.76)mm比(45.37±5.38)mm]、LVESd[(39.36±4.84)mm比(32.69±3.67)mm]、血清cTnI[(0.58±0.14)μg/L比(0.31±0.05)μg/L]、Mb[(102.32±10.64)μg/ml比(87.36±9.63)μg/ml]、CK-MB[(9.26±1.53)ng/ml比(5.28±0.64)ng/ml]、H-FABP[(10.94±1.92)ng/ml比(6.36±0.74)ng/ml]、NT-proBNP[(1936.67±263.38)ng/ml比(1179.35±127.84)ng/ml]、TNF-α[(0.97±0.18)ng/ml比(0.83±0.24)ng/ml]、ET[(71.53±8.47)ng/ml比(58.36±6.54)ng/ml]水平显著降低,LVEF[(48.42±5.36)%比(54.81±6.04)%]显著升高(P均<0.01)。治疗期间,联合治疗组不良心血管事件发生率显著低于右美托咪啶组(10.42%比31.25%),P=0.012。结论:电针内关联合右美托咪啶能显著改善AMI急诊PCI患者心功能,降低血清心肌损伤标志物、NT-proBNP、TNF-α、ET水平,安全性好,值得推广。

Objective:To study therapeutic effect of electrical acupuncture at Neiguan combined dexmedetomidine on AMI patients undergoing emergency PCI and its influence on serum levels of N-terminal pro-brain natriuretic peptide(NT-proBNP),tumor necrosis factor(TNF)-αand endothelin(ET).Methods:A total of 96 AMI patients undergoing emergency PCI in our hospital from Aug 2016 to Aug 2017 were randomly and equally divided into dexmedetomidine group(received dexmedetomidine based on routine treatment)and combined treatment group(received electrical acupuncture at Neiguan based on dexmedetomidine group).Both groups were treated for 5d.Cardiac function indexes:left ventricular end-diastolic dimension(LVEDd),left ventricular end-systolic dimension(LVESd),LVEF,serum levels of cardiac troponin I(cTnI),myoglobin(Mb),creatine kinase isoenzyme MB(CK-MB),heart type fatty acid-binding protein(H-FABP),NT-proBNP,TNF-αand ET before and after treatment and incidence rate of adverse cardiovascular events were observed and compared between two groups.Results:Compared with dexmedetomidine group after treatment,there were significant reductions in LVEDd[(51.32±5.76)mm vs.(45.37±5.38)mm],LVESd[(39.36±4.84)mm vs.(32.69±3.67)mm],serum levels of cTnI[(0.58±0.14)μg/L vs.(0.31±0.05)μg/L],Mb[(102.32±10.64)μg/ml vs.(87.36±9.63)μg/ml],CK-MB[(9.26±1.53)ng/ml vs.(5.28±0.64)ng/ml],H-FABP[(10.94±1.92)ng/ml vs.(6.36±0.74)ng/ml],NT-proBNP[(1936.67±263.38)ng/ml vs.(1179.35±127.84)ng/ml],TNF-α[(0.97±0.18)ng/ml vs.(0.83±0.24)ng/ml]and ET[(71.53±8.47)ng/ml vs.(58.36±6.54)ng/ml],and there was significant rise in LVEF[(48.42±5.36)%vs.(54.81±6.04)%]in combined treatment group(P<0.01 all).During treatment,incidence rate of adverse cardiovascular events in combined treatment group was significantly lower than that of dexmedetomidine group(10.42%vs.31.25%),P=0.012.Conclusion:Electrical acupuncture at Neiguan combined dexmedetomidine can significantly improve cardiac function and reduce serum levels of myocardial injury markers,NT-proBNP,TNF-αand ET with good safety in AMI patients undergoing emergency PCI,which is worth extending.