冠状动脉内注射地尔硫卓治疗急性冠脉综合征疗效观察

Curative effect of intracoronary injection of diltiazem on acute coronary syndrome

目的观察经冠状动脉(冠脉)注射地尔硫卓治疗对急性冠脉综合征(ACS)患者血清心脏标志物、可溶性Fas配体(sFasL)浓度及心室重构的影响。方法纳入106例ACS患者,随机分为观察组(n=55)和对照组(n=51),观察组在经皮冠状动脉介入术(PCI)中(第一次球囊扩张)后即刻冠脉内注射地尔硫卓1000μg,输注速度为50μg/s;对照组在PCI后即刻注射生理盐水10ml,输注速度为1ml/s。PCI术前、术后24h检测心脏标志物[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTNI)];PCI术前、术后2周检测sFasL浓度;PCI术前、术后3个月、术后6个月及术后12个月行超声心动图检查,观察心室重构情况。结果 PCI术前,观察组与对照组心脏标志物和sFasL浓度无统计学差异(p>0.05);术后24h心脏标志物检测和术后2周sFasL检测示对照组水平明显高于观察组(P<0.05)。PCI术前,两组患者的超声结果[包括左室射血分数(LVEF)、舒张末期容积指数(EDVI)和收缩末期容积指数(ESVI)]无统计学差异;PCI术后各检查时间点,观察组上述值均较对照组有明显改善(P<0.05)。结论冠脉内注射地尔硫卓治疗ACS可减少心肌细胞损伤和心肌细胞凋亡,抑制心室重构,改善心功能。

Objective To observe the influences of intracoronary injection of dihiazem on the concentration of serum cardiac enzymes and soluble Fas ligand （sFasL） and ventrieular remodeling in the patients with acute coronary syndrome （ACS）. Methods There were 106 ACS patients selected, and then they were randomly divided into observation group （n=55） and control group （n=51）. The observation group was given intracoronary injection of 1000 IX g diltiazem （50 μ g/s） immediately after PCI （first balloon dilatation）, and control group was given injection of 10 ml normal saline solution （1 ml/s）. The concentration of serum cardiac enzymes （CK, CK-MB and cTNI） were detected within 24 hours before and after PCI. The concentration of sFasL was detected within two weeks before and after PCI. The patients were given examination of ultrasonic cardiogram （UCG） before PCI and 3 months, 6 months and 12 months after PCI for observing ventricular remodeling. Results Before PCI there was no significant difference in the concentration of serum cardiac enzymes and sFasL between two groups. The concentration of serum cardiac enzymes 24 hours after PCI and concentration of sFasL 2 weeks after PCI were significantly higher in control group than those in observation group （P〈0.05）. Before PCI, there was no significant difference in the results of UCG （including LVEF, EDVI and ESVI） between two groups, and after PCI these indexes were all improved in observation group compared with control group at all time points （P〈0.05）. Conclusion The intraeoronary injection of diltiazem for treating ACS can relieve myocardial damage, reduce myocardial apoptosis, inhibit ventricular remodeling and improve heart function.