连续监测BNP及D-二聚体在急性心肌梗死急诊PCI术后的应用

Application of BNP and D-dimer in the acute myocardial infarctionn after emergency PCI

目的通过连续监测B型脑钠肽(BNP)及D-二聚体(D.D)水平,观察急性心肌梗死急诊经皮冠状动脉介入治疗(PCI)术后疗效及其预后。方法收集肇庆市第一人民医院成功实施急诊PCI的急性心肌梗死患者100例为PCI组,同期未行急诊PCI术的急性心肌梗死患者100例为药物保守治疗组,采用荧光免疫分析仪分别检测两组治疗前,治疗后第1、2、3、7、14天的BNP及D.D水平。结果 PCI组术后第1天至第14天BNP水平,较药物保守治疗组低,差异有统计学意义(P<0.01);PCI组术后3天D.D水平均较术前、药物保守治疗组同期水平显著升高,差异有统计学意义(P<0.01),两组术后第7、14天D.D水平比较,差异无统计学意义(P>0.05)。PCI组的左室射血分数(LVEF)为(48.76±6.53)%,较药物保守治疗组的(41.78±5.18)%高,差异有统计学意义(P<0.05);相关性研究显示,BNP水平与LVEF之间呈负相关(r=-0.5774,P<0.01)。结论连续监测急诊PCI术后BNP及D.D的水平,能对患者术后心功能及体内凝血和纤溶状态进行较全面的评估,有助于指导近期急性心肌梗死的治疗和预后判断,减少术后并发症及心脏不良事件的发生。

Objective To evaluate the efficacy and prognosis of emergency percutaneous coronary intervention （PCI） in acute myocardial infarction by continuously monitoring the levels of brain natriuretic peptide （BNP） and D-dimer. Methods 200 acute myocardial infarction patients were received respectively PCI （n=100） and conservative treatment （n=100）. The levels of BNP and D-dimer were determined by fluorescence immunity analyzer before treatment and in the 1, 2, 3, 7 and 14 days after treatment. Results The level of BNP in 1 days to 14 days after operation in the PCI group was lower than that in the conservative treatment group, there was a significant difference between the two groups （P〈0.01）. The level of D-dimer in 3 day after operation in the PCI group was higher than that in the conservative treatment group （P〈0.01）; and the level of D-dimer in 7 ＆ 14 days after operation was not significantly difference between the two groups （P〉0.05）. The LVEF in the PCI group （48.76±6.53）%） was higher than that in the conservative treatment group （41.78±5.18）%, the difference was statistically significant （t=8.37, P〈0.01）.Related studies show that the BNP was negatively correlated with LVEF （r=-0.5774, P〈0.01 ）. Conclusions Continuously monitoring the levels of BNP and Ddimer after emergency PCI can be fully evaluated the postoperative cardiac function and the state of coagulantion and fibrinolysis, help guide the treatment and prognosis of acute myocardial infarction, reduce the occurrence of postoperative complication and cardiac adverse events.