主动脉内球囊反搏治疗急性心肌梗死急诊冠状动脉介入治疗术后无复流现象的临床研究

Effect of intraaortic balloon pumping on no-reflow phenomenon in emergency percutaneous coronary intervention

目的:探讨主动脉内球囊反搏(IABP)在急性心肌梗死(AMI)急诊冠状动脉介入治疗(PCI)术后无复流(NR)现象中的治疗作用。方法:分析自2006-01-2010-08期间因AMI行PCI术后NR患者30例资料,采用单双日法分组方法将其中16例运用IABP治疗,其余未用IABP的14例为对照组,观察术后10d内心肌损伤标志物、脑钠肽(BNP)及血管活性物质恢复情况。心肌损伤标志物包括肌红蛋白、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI);血管活性物质指标包括肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、肾上腺素(E)、去甲肾上腺素(NE);治疗10d后应用彩色超声心动图测量患者左房内径、左室内径、左室射血分数(LVEF);并随访3个月、6个月左房内径、左室内径、LVEF变化情况。结果:IABP治疗组患者血管活性物质及心肌损伤标志物指标时间-浓度曲线显示指标下降明显快于对照组,2组间血管活性物质及心肌损伤标志物与对照组相比,2组下降幅度差异有统计学意义(P<0.05);IABP组BNP峰值较对照组提前,IABP治疗组BNP指标时间-浓度曲线显示指标下降明显快于对照组,2组间BNP指标下降与对照组相比差异无统计学意义(P>0.05);超声心动图测量2组患者10d、3个月及6个月时左房内径、左室内径及LVEF差异有统计学意义(P<0.05)。结论:IABP能够加速降低AMI急诊PCI术后发生NR患者升高的交感神经系统、RAS系统激素及心肌损伤标志物的水平;使BNP峰值提前并改善10d、3个月及6个月时左房内径、左室内径及射血分数值。

Objective：To investigate the effect of intra-aortic balloon pumping（IABP） on no-reflow phenomenon in emergency percutaneous coronary intervention（PCI）.Method：Clinical data of 30 acute myocardial infarction patients after PCI with angiographic no-reflow phenomenon were retrospectively analyzed between January 2006 and August 2010.16 patients were performed IABP.Other 14 patients served as control group.Observe differences of cardiac structure,brain natriuretic peptide and cardiac ventricle systolic function between two groups,and several Vasoactive substances including plasma renin activity（PRA）,aldosterone（ALD）,angiotensin Ⅱ（ANGⅡ）,norepinephrine（NE） and epinephrine（E） as well as Cardiac injury markers（MYO,CK-MB,cTnI） in both groups on the days of 1,2,3,5,7,10 after the different interventions.In addition,cardiac structure and cardiac ventricle systolic function including Left atrium medial diameter（LAMD）,left ventricular medial diameter（LVMD）,left ventricular ejection fraction（LVEF） was evaluated after 10 days,3 months,6 months.Finally,statistics was taken to analyze the data.Result：The time-concentration curves demonstrated that vasoactive substances and cardiac injury markers in IABP group decreased obviously earlier than control group,and there was significant difference in the decrease extent between these two groups（P0.05）.Compared with control group,BNP in IABP group reached peak earlier and decreased earlier with significant differences.However,there was no significant difference in the decrease extent between these two groups（P0.05）.UCG demonstrated that there were significant differences in LAMD,LVMD,LVEF of 10 days,3 months,6 months between these two groups（P0.05）.Conclusion：IABP had effects on prognostic value in AMI patients underwent PCI with angiographic no-reflow phenomenon.