地尔硫对急性冠状动脉综合征患者冠状动脉介入治疗后的影响

Effect of diltiazem in patients with acute coronary syndrome following percutaneous coronary intervention

目的:探讨地尔硫对急性冠状动脉综合征(ACS)患者冠状动脉介入治疗(PCI)后的影响。方法:选取入住四川大学华西医院心内科、经冠状动脉造影确诊为ACS,并接受PCI的患者共53例,随机分为地尔硫组和对照组,地尔硫组于PCI后即刻给予地尔硫5μg·kg-1·min-1,持续24h。观察2组心绞痛发作次数,2组术前,术后即刻、24、48、72h血压、心率、心肌氧耗指数变化,以及C反应蛋白(CRP)和氨基末端脑钠肽前体(NT-proBNP)水平。结果:①2组在观察期内心绞痛发作次数差异无统计学意义[地尔硫组(2·6±1·2)次,对照组(2·8±1·5)次]。②2组在术前和术后即刻血压、心率并无显著差异,但术后24h地尔硫组较对照组血压、心率均有明显降低[地尔硫组:血压(122·8±16·6)/(72·5±6·7)mmHg,心率(67·4±8·5)次/min;对照组:血压(135·6±18·9)/(86·2±9·7)mmHg,心率(78·9±10·6)次/min],2组比较差异有统计学意义(均P<0·01),且一直保持到术后72h,地尔硫组可有效降低心肌氧耗指数。③2组在术前和术后即刻CRP、NT-proBNP并无显著差异,但术后较术前CRP、NT-proBNP水平升高[地尔硫组:术前CRP(20·4±4·3)mg/L,NT-proBNP(254·2±31·7)ng/L,术后即刻CRP(39·8±8·6)mg/L,NT-proBNP(448·9±51·2)ng/L;对照组:术前CRP(18·6±5.2)mg/L,NT-proBNP(210.5±29.8)ng/L,术后即刻CRP(41.2±9.1)mg/L,NT-proBNP(502.6±57.4)ng/L]。术后24h地尔硫组较对照组CRP、NT-proBNP均有明显降低[地尔硫组:CRP(25.2±3.2)mg/L,NT-proBNP(202.5±21.4)ng/L;对照组:CRP(39.7±8.5)mg/L,NT-proBNP(482.3±49.7)ng/L,2组比较差异有统计学意义(P<0·05),且一直保持到术后72h。结论:地尔硫可降低ACS患者PCI后的心率、血压和心肌氧耗指数,并可显著降低PCI后CRP和NT-proBNP水平,有可能改善ACS患者PCI的预后。

Objective： To investigate the effect of intravenous diltiazem in patients with acute coronary syndrome following percutaneous coronary intervention. Method： A total of 53 patients diagnosed as acute coronary syndromes and underwent percutaneous coronary intervention were enrolled. They were randomized into diltiazem and control group. The diltiazem group was administered 5 μg · kg^-1 · min^-1 for 24 hours by intravenous infusion following PCI. Angina peetoris , blood pressure and heart rates were recorded. All patients underwent CRP and NT-proBNP assay in baseline and 0, 24, 48, and 72 hours post-PCI. Result： ①Angina pectoris between two groups had no significant difference（diltiazem group： [2. 6±1.2] times, control group： [2. 8± 1.5] times）. ② Blood pressure and heart rate were similar in baseline and 0 hour post PCI in two groups, however, diltiazem lowered blood pressure, heart rate and myocardial oxygen consumption index significantly since 24 hours after PCI （diltiazem group., systolic blood pressure [122.8±16.6] mmHg, diastolic blood pressure [72.5±6.7] mmHg, heart rate [67.4±8.5] beats/rain; control group： systolic blood pressure [135.6±18.9] mmHg, diastolic blood pressure [86.2±9.7] mmHg, heart rate [78.9±10.6] beats/min）. The effect was kept over 72 hours. ③Although CRP and NT-proBNP were similar in baseline and 0 hour following PCI in two groups, diltiazem lowered CRP and NT-proBNP significantly since 24 hours after PCI NP （diltiazem group： CRP [25.2±3.2] mg/L, NT-proB[ 202.5 ± 21.4] ng/L ; controlgroup： CRP [39.7 ± 8. 5]mg/L,NT-proBNP[482.3±49. 7]ng/L）. The effect was kept over 72 hours. Conclusion： Intravenous diltiazem can significantly lower blood pres sure, heart rate, myocardial oxygen consumption index, CRP, and NT-proBNP after PCI. It may influence the outcome of PCI for patients with acute coronary syndromes.