地佐辛对AMI的临床效果和血浆儿茶酚胺的影响

Clinical curative effect of dezocine on acute myocardial infarction and the effect on plasma catecholamines

目的观察地佐辛对急性心肌梗死（AMI）的临床效果和血浆肾上腺素、去甲肾上腺素的影响。方法选择我院46例药物治疗的AMI患者[发病时间均在24h内，视觉模拟疼痛评分（VAS）≥4分]，随机分为地佐辛治疗组（D组）和常规治疗组（R组），每组23例。D组人院时首先给予静脉注射地佐辛5mg，随后两组常规药物治疗，每隔15min观察两组治疗效果，如果VAS评分≥7分，静脉注射吗啡5mg，观察治疗3h。同期选取20例健康志愿者为对照组（C组），不予干预。记录治疗3h内各组注射吗啡数量和出现的心律失常，测定治疗前后VAS评分、血浆肾上腺素（E）、去甲肾上腺素（NE）及肌钙蛋白Ⅰ（cTnI）水平。结果AMI疼痛患者血浆N、NE测定值均显著高于c组，差异有统计学意义（P〈0．05）；治疗3h后，D组使用吗啡的数量、VAS评分、N、NE测定值及恶性心律失常发生率均显著低于R组，两组比较差异有统计学意义（P〈0．05）；D组cTnI测定值低于R组，但差异无统计学意义（P〉0．05）。结论地佐辛能有效地缓解AMI患者疼痛，抑制交感神经过度兴奋，降低血浆儿茶酚胺水平，减轻心肌损伤，减少恶性心律失常发生，还能减少临床吗啡用药量。

Objective To observe the clinical effects of dezocine in acute myocardial infarction and its effect on plasma epinephrine and norepinephrine. Methods 46 patients with acute myocardial infarction （AMI） （admission less than 24 h from the onset of pain and pain score≥4 on a 10 -grade visual analog scale ） were randomly divided into conventional treatment group （R group, 23 cases）. a dezocine group （D group, 23 cases ） and a On admission the patients in group D immediately received 5 mg dezocine intravenously, and then the two groups were access to conventional drug treatment. Every 15 minutes after the start of treatment, if pain score≥7, the patient would receive 5 mg morphine intravenously. Another 20 healthy volunteers without any interventions served as a control group （ C group）. During the first three hours of treatment, the need for morphine and the occurrence of arrhythmias were recorded. Venous plasma levels of epinephrine （ E ）, norepinephrine （ NE ）, cardiac truponin Ⅰ （cTnI） as well as visual analogue scale （VAS） scores for pain were measured before and after treatment. Results Plasma E and NE levels in AMI patients suffering from pain were significantly higher than those in group C （P 〈 0.05）. After 3 hours of treatment, the need for morphine, VAS, the level of E and NE, malignant arrhythmias in group D were lower than those in group R （ P 〈 O. 05 ）. The level of cTnI was lower in group D than that in the group R, but the difference was not statistically significant （P 〉 0.05）. Conclusion 5 mg of dezocine intravenously （per dose） can effectively relieve the pain among AMI patients, inhibit the over - excitement of sympathetic nerves, which is beneficial in diminishing the incidence of malignant arrhythmias and preventing the myocardial injury, and reducing the need for morphine.