DPD对ACS急诊PCI术神经内分泌因子及并发症的影响

Effect of Distal Protection Device on the Level of Neuroendocrine and Complications in Emergency Percutaneous Coronary Intervention in Acute Coronary Syndrome

目的探讨急性冠脉综合征(ACS)患者急诊经皮冠状动脉成形术(PCI)中远端保护装置对神经内分泌因子水平的影响。方法回顾性分析在我院行急诊PCI的67例ACS患者,依据是否应用远端保护装置分为研究组(应用远端保护装置)32例和对照组(未应用远端保护装置)35例。在术前及术后第1、3、5、7天分别测定并比较血浆中内皮素(ET)、肾上腺素(E)、去甲肾上腺素(NE)、肾素活性(PRA)、醛固酮(ALD)和血管紧张素Ⅱ(AngⅡ)水平。随访1个月,比较两组的急性血栓形成、亚急性血栓形成及猝死率等并发症的差异。结果研究组患者各因子水平随时间延长而降低(P<0.05);对照组ET、E、NE无明显变化(P>0.05),而PRA、ALD、AngⅡ水平随时间延长而降低(P<0.05)。两组术前及术后1d的PRA、ALD、AngⅡ水平无差异(P>0.05),而从术后3d开始,研究组PRA、ALD、AngⅡ水平较对照组明显偏低(P<0.05)。随访1个月后,研究组的急性血栓形成、亚急性血栓形成及猝死率均明显低于对照组(P<0.05或P<0.01)。结论 ACS患者急诊PCI中使用远端保护装置能降低术后RAS系统水平,减少并发症发生。

Objective To analyze the clinical effect of Percusurge distal protection device（DPD） on the level of plasma neuroendocrine and complications in emergency pereutaneous coronary intervention（PCI） in acute coronary syndrome（ACS）. Methods A total of 67 patients with ACS by emergency PCI in our hospital were collected to retrospective analyses and divided into two groups, research group（applieated Percusurge DPD, 32 patients） and control group（non-applicated Percusurge DPD, 35patients）, according to whether Percusurge DPD was applieated. The plasma levels of endothelin（ET）, ePinephrine（E）, norepinephrine（NE）, plasma renin activity（PRA）, aldosterone（ALD） and angiotensin II （ Ang II ） were measured on the day of operation and on the 1st, 3rd, 5th and 7th day after operation, respectively. After 1 month follow-up, the incidence of complications, such as acute coronary stent thrombosis, sub-acute coronary stent thrombosis and sudden death, were compared between two groups. Results The plasma levels of all the neuroendocrine elements in research group were decreasing aecompanyed therapy duration （P 〈 0.05 ）. The plasma levels of ET, E, NE in control group were no ehanging（P 〉 0.05）, but PRA, ALD, Ang II in control group were decreasing accompanyed therapy duration （ P 〈 0.05 ）. The plasma levels of PRA, ALD, Ang IX in research group at pre-operation and the 1st day after operation were no difference betweell two groups（P 〉 0.05）. Compared to control group, the plasma levels of PRA, ALD, Ang II were rapidly decreased in research group from the 3rd day after the operation（P 〈 0.05）. After 1 month follow-up, the incidence of complications in research group were obviously lower than in control group（P 〈 0.05 or P 〈 0.01）. Conclusion In patients with ACS, the Pereusurge DPD could decrease the plasma levels of RAS system and the ＇incidence of complications during emergency PCI.