急诊介入手术对急性ST段抬高心肌梗死患者血浆B型钠尿肽水平的影响

Influence of PCI on plasma B-type natriuretic peptide in patients with acute ST elevated myocardial infarction

目的探讨急诊介入手术对急性ST段抬高心肌梗死患者血浆B型钠尿肽(BNP)水平的影响。方法选择2008年1月至12月因急性ST段抬高心肌梗死收入我院心内科重症监护室的193例患者,所有患者根据病史在距离发病18 h行床边即时BNP检测。根据是否行急诊经皮冠状动脉介入治疗(PCI)将患者分为急诊PCI组(92例)和药物保守治疗组(101例),再将急诊PCI组根据发病来院时间,分为两个亚组,Ⅰ组(发病时间≤3 h,n=42)和Ⅱ组(发病时间3～6 h,n=50),比较二者BNP水平。结果急诊PCI组的BNP水平明显低于药物保守治疗组,差异有统计学意义(261.0±410.9 ng/L比921.5±1126.7 ng/L,P<0.01)。闭塞血管开通越早,BNP降低越明显。术后血流未达TIMI 3级的患者BNP水平不能显著降低。结论尽早地开通梗死相关血管,恢复梗死相关动脉TIMI 3级血流再灌注,可有效地挽救濒死的心肌,减轻心室重构,保护心功能,改善患者预后。

Objective To investigate whether emergency percutaneous coronary intervention（PCI） could influence the BNP level in patients with ST-segment elevation myocardial infarction（STEMI）.Methods We enrolled 193 patients who were admitted with STEMI.The BNP levels were measured at admission.All patients underwent routine clinical laboratory tests in the first day of hospitalization.Ninety-two patients underwent emergency PCI and the other 101 patients received conservative medicine treatment.The patients who had emergency PCI were divided into two subgroups according to the time between symptom onset and PCI started（ictus time 0-3 h,n=42;ictus time 3-6 h,n=50） for analysis.Results BNP levels were significantly lower in patients undergoing PCI when compared with conservative medicine treatment（261.0±410.9 ng/L vs 921.5±1126.7 ng/L,P〈0.01）.BNP levels lowered significantly as the ictus time shortened.BNP levels were higher in patients who did not acquired TIMI 3 flow.BNP levels were also positively related with CK-MB.Conclusion Early reperfusion of infarct-related artery results in lower BNP level which favours myocardial salvage and preservation of heart function.