急诊与择期血运重建对急性心肌梗死患者心功能和神经内分泌激素的影响比较

Effect of emergency and elective revascularization on ventricular function,neurohormones in the patients with myocardial infarction

目的探讨急诊和择期血运重建治疗对急性心肌梗死(AMI)患者心功能、心室重塑、神经内分泌活性的影响。方法对45例AMI患者分别予急诊血运重建治疗(n=20)和择期血运重建治疗(n=25);分别检测AMI后1周和6个月的左室舒张末期内径(LVEDD)、左室射血分数(LVEF)及二尖瓣血流舒张早期流速与心房收缩期流速的比值(VE/VA)和血清去甲肾上腺素(NE)、肾素活性(RA)、血管紧张肽Ⅱ(AngⅡ)及醛固酮(ALD)的含量。结果与择期血运重建组同时点亚组比较,急诊血运重建组各亚组的NE均显著降低(P<0.05);急诊血运重建组6个月亚组的NE、择期血运重建组6个月亚组的NE和RA均显著低于相应同组1周亚组(P<0.05);两组的AngⅡ、ALD、LVEDD、LVEF和VE/VA于组间和组内比较,差异无统计学意义(P>0.05)。结论急诊血运重建抑制AMI后交感神经系统过度激活的作用强于择期血运重建,但在进一步抑制肾素-血管紧张肽-醛固酮系统、心室重塑,改善心脏收缩和舒张功能方面并不具备更大的优势。

Objective To evaluate the effects of emergency and elective revascularization on ventricular remodeling,function and neurohumoral activity in the patients with acute myocardial infarction（AMI）.Methods According to the different therapies,45 patients with AMI were divided into emergency revascularization group（n=20）and elective revascularization group（n=25）.The left ventricular end-diastolic diameter（LVEDD）,left ventricular ejection fraction（LVEF）and VE/VA were determined by echocardiography on the 1st week and the 6th month after AMI.Enzyme-linked immunosorbent assay was used to detect serum level of norepinephrine（NE）,renin activity（RA）,angiotensin Ⅱ（AngⅡ）and aldosterone（ALD）at the same time.Results Compared with the elective revascularization group,serum concentration of NE in emergency group on the first week and the 6th month were decreased（P〈0.05）.The serum level of NE in both of the groups and RA in the elective revascularization group on the 6th month after AMI were significantly lower than those in the same groups on the 1st week respectively（P〈0.05）.There were no significant differences in AngⅡ,ALD,LVEDD,LVEF and VE/VA between the two groups at any time（P〉0.05）.Conclusion Emergency revascularization appears to be superior to elective revascularization with respect to suppression of sympathetic nervous system activation in the patients with AMI,but the effect on renin-angiotensin-aldosterone system,ventricular remodeling and function are very similar in two groups.