前列地尔对急诊PCI术后无复流患者的影响

Effects of alprostadil on patients with no reflow phenomenon after emergent percutaneous coronary intervention

目的探讨前列地尔对急诊经皮冠状动脉治疗(Percutaneous Coronary Intervention,PCI)术后无复流患者的心电图、心功能及心血管事件的影响。方法我院2008年8月至2012年4月因急性ST段抬高型心肌梗塞(小于12h)并行急诊PCI术,术后出现TIMI血流<3级患者共36例,随机分为治疗组(20例)和对照组(16例),对照组予常规治疗,治疗组为常规治疗+前列地尔20μg ivgtt每天1次,疗程10 d。对比两组患者术前及术后24 h心电图变化,心脏彩超检测心功能(住院期间和8个月后),并随诊8个月后返院复查冠脉造影评价血管狭窄率、观察两组心血管事件的发生率。结果与对照组相比,治疗组术后24h心电图ST段回落大于50%者多于对照组(P<0.05);给药后8个月左室射血分数(LVEF%)提高(P<0.05);心绞痛、心肌梗死等心血管事件发生率降低(P<0.05);血管再发狭窄率降低(P<0.05)。结论前列地尔能改善急诊PCI术后无复流患者的左心功能,降低术后8个月内心血管事件的发生率及血管再狭窄率。

Objective To investigate the effects of alprostadil on electrocardiogram （ECG）, left ven- tricular function and cardial vascular events in patients with no reflow phenomenon after emergent percu- taneous coronary intervention （PCI）. Methods Thirty -six patients with chest pain no more than 12h di- agnosed with acute ST- elevation myocardial infarction were given direct PCI followed by the coronary blood less than TIMI 3 grade after PCI using coronary angiography in the Affiliated Hospital of Zunyi Medical College from August, 2008 to April, 2012. All patients were randomly divided into the control group （16 patients） receiving regular treatment for coronary treatment for coronary heart disease and treatment group （20 patients）, receiving regular treatment and additional alprostadil （20 ug） by intra- venous infusion once a day for 10 days. ECG variation was measured before operation and 24 h after op- eration. Patient left ventricular function was determined by echocardiography in hospital and 8 months after PCI followed by the assessment of hemal stricture rate via coronary angiogram （CAG） and further evaluation of cardiovascular events incidence. Results Patients with the ratio of ST segment over 50% in treatment group were more than those in control group 24 h after PCI. Compared with the control group, left ventricular ejection fraction （LVEF） was improved in treatment group 8 months after treatment and the incidence rate of cardiovascular events including angina, myocardial infarction and vascular resteno- sis was reduced. Conclusion Alprostadil could ameliorate the left ventricular ejection fraction and de-crease cardiovascular events incidence and vascular restenosis rate in patients with no reflow phenome- non after emergent PCI.