米诺环素后处理对急性心肌梗死溶栓后早期心律失常的影响

The effect of minocycline postconditioning in early stage of thrombolytic therapy on acute myocardial infarction

目的观察米诺环素后处理对急性心肌梗死(AMI)溶栓治疗早期的影响,确定米诺环素能否作为后处理药物减轻心肌缺血再灌注损伤。方法 65例胸痛发作<12 h ST段抬高型AMI患者,随机分为两组。①对照组,32例,尿激酶(UK)静脉溶栓,AMI常规用药;②处理组,33例,米诺环素200 mg静脉推注后UK溶栓,与静脉溶栓同步再予米诺环素200 mg静脉点滴,AMI常规用药。CCU病房24 h观察病情变化,记录心律失常,抽血查心肌酶。结果溶栓后2 h内ST段回落≥50%和>70%的比例,冠状动脉再通的比例,处理组高于对照组(P<0.05)。再灌注心律失常的发生率,处理组低于对照组(P<0.05)。溶栓后24 h内处理组的心肌酶峰值和恶性心律失常发生率明显低于对照组(P<0.05)。结论米诺环素后处理减轻了AMI再灌注损伤,提高了UK溶栓的再通率,降低了再灌注心律失常和恶性心律失常的发生。

Objective To observe the effect of minocycline postconditioning in early stage of thrombolytic therapy on a- cute myocardial infarction（AMI）, to determine whether minocycline can be a postconditioning drugs to reduce myocardial ischemia-reperfusion injury. Methods Sixty-five patients,whose chest pain episodes less than 12 h and were diagnosed as ST elevation AMI, were randomly divided into two groups：（）1The control group, 32 patients, UK thrombolysis and AMI conventional medication; （2）The treatment group, 33 patients, intravenous injection of minocycline 200 mg before UK thrombolysis, and intravenous injection of minocycline 200 mg during intravenous thrombolysis followed by conventional medication. Observating pathogenetic condition for 24 h in CCU ward, blood was withdrawn to investigate myocardial en- zymes. Results The treatment groups had a higher proportion in ST segment fall more than 50% and 70% compared with the control group; The proportion of the coronary artery recanacization rate in the treatment group was higher than those in the control group（P 〈 0.05 ）. The incidence of reperfusion arrhythmias （RA） in the treatment groups was lower than that in the control group （P 〈 0.05）. Thrombolysis of treatment groups within 24 h after myocardial enzymes peak and malignant arrhyth- mia rate was significantly lower than the control group （ P 〈 0.05 ）. Conclusion Minocycline postconditioning reduces reperfusion injury of AMI and improve recanalization rate of the UK thrombolysis, reducing incidence rate of reperfusion ar- rhythmia and malignant arrhythmia.