大剂量脉络宁对急性心肌梗塞溶栓治疗再灌注性损伤的防治

Preventive effect of high dosage “mai luo ning” on reperfusion injury after thrombolytic therapy in patients with acute myocardial infarction

目的：探讨急性心肌梗塞（ＡＭＩ）再灌注性损伤的防治方法。方法：选择具有溶栓指征的ＡＭＩ患者１３８例，随机分为治疗组与对照组（各６９例）。２组均进行尿激酶静脉溶栓治疗。治疗组在用尿激酶前１０～３０分钟或同时应用脉络宁４０～５０ｍｌ，每天１次，连用７天。对照组只用尿激酶及常规治疗。结果：治疗组与对照组再通分别为５３例（７６．８％）和４９例（７１．０％）；住院期间死亡分别为２例（２．９％）和６例（８．７％）；发生严重心力衰竭分别为４例（５．８％）和７例（１０．１％）；发生再灌注性心律失常分别为２２例（３１．９％）和３８例（５５．１％），２组比较差异均显著（Ｐ＜０．０５或＜０．０１）。同时，治疗组在减少心肌耗氧量、缩小梗塞面积、减少心肌酶的释放和提高左室射血功能等方面都显著优于对照组（Ｐ均＜０．０５）。结论：大剂量脉络宁具有抗ＡＭＩ再灌注性损伤的作用，并且以连用７天为宜。

Objective:To explore the potential measures for prevention and treatment of reperfusion injury in patients with acute myocardial infarction (AMI).Methods:One hundred and thirtyeight patients with AMI receiving thrombolytic therapy were included in this study.Patients were randomly divided into treatment group and control group,and all received urokinase injection.In treatment group,“mai luo ning”(40～50 ml)was injected 10￣30 minutes before or at the same time as the urokinase treatment,and it was given once a day and continued for 1 week.But control group received only urokinase and conventional treatment.Results:Reperfusion rate and mortality were 76 8% (53 cases) and 2 9% (2 cases ) in treatment group,and 71 0%(49 cases) and 8 7% (6 cases) in control group respectively.Also,it was shown that incidences of heart failure and reperfusion arrhythmia were 5 8% (4 cases)and 31 9% (22 cases) in treatment group,and 10 1%(7 cases) and 55 1%(38 cases) in control group respectively,and these differences were significant( P <0 05 or P <0 01).Furthermore,“mai luo ning” could markedly decrease oxygen consumption of myocardium,lessen myocardial infarction size,reduce release of serum myocardium enzyme,and improve left ventricular ejection function compared with controls (all P <0 05).Conclusions:High dosage of “mai luo ning” may be of significant advantage in prevention of reperfusion injury associated with AMI,and it is suitable to use continuously for 1 week.