硝酸异山梨酯对急性ST段抬高性心肌梗死直接支架术后心衰患者心功能的影响

Effect of isosorbide dinitrate on heart function of acute ST-elevation myocardial infarction patients after primary percutaneous coronary artery intervention

目的 评价硝酸异山梨酯对急性ST段抬高性心肌梗死（STEMI）直接支架术（PCI）后心衰患者心功能的影响. 方法 回顾性分析2006-01～2012-01住院65例急性ST段抬高性心肌梗死行直接支架术后发生心功能不全患者,使用硝酸异山梨酯治疗患者为观察组,使用冻干重组人脑利钠肽治疗患者为对照组.比较两组患者临床资料、冠状动脉造影、应用临时起搏器、经皮主动脉球囊反搏（IABP）、支架使用和术后罪犯血管TIMI血流;比较两组患者治疗前及治疗后心功能指标：脑钠肽（BNP）、左室射血分数（LVEF）、心脏指数（CI）、早期血流峰值速度（E）、晚期血流峰值速度（A）、E峰与A峰比（E/A）及治疗后30 d内不良心脏事件（MACE）发生情况. 结果 两组患者除高脂血症外的临床资料、冠状动脉造影、应用临时起搏器、IABP、支架使用和术后罪犯血管TIMI血流差异均无统计学意义（P＞0.05）.治疗前两组患者心功能指标差异无统计学意义（P＞0.05）.观察组治疗后30 d心功能指标均优于对照组,但差异无统计学意义（P＞0.05）.两组患者治疗后心功能均优于治疗前,差异有统计学意义（P＜0.05）.观察组患者MACE发生明显少于对照组,差异有统计学意义（P＜0.05）. 结论 急性ST段抬高性心肌梗死行直接支架术后发生心衰患者,使用硝酸异山梨酯或冻干重组人脑利钠肽治疗均能使患者心功能明显改善,且使用硝酸异山梨酯治疗后30 d心绞痛发作更少.

Objective To evaluate the effect of isosorbide dinitrate on the heart function of acute ST-elevation myocardial infarction （STEMI） patients after primary percutaneous coronary artery intervention（PCI）.Methods The clinical data of 65 acute STEMI patients who had heart failure after primary PCI in Xi＇ an Gaoxin Hospital from January 2006 to January 2012 were retrospectively analyzed.The patients were treated with isosorbide dinitrate in observation group and lyophilized recombinant human brain natriuretic peptide in control group.The level of BNP was determined by BIOSITE Triage Meterpro before treatment and 30 d after treatment.The changes of left ventricular ejection fraction （LVEF）,cardiac index （CI）,early peak flow velocity （E）,late peak flow velocity （A） and ratio of E peak to A peak（E/A）were determined by GE vivi7 ultrasound system before treatment and 30 d after treatment.Major adverse cardiovascular events （MACE） during hospitalization and 30 d after treatment were recorded and compared between two groups.Results There was no statistical difference in the aspects of clinical features,temporary pacemaker,IABP profile of DES implantation and the blood flow rate of TIMI3 between two groups except of hyperlipemia（P ＞ 0.05）.There was no statistical difference in BNP concentration,the entries of LVEF,CI and E/A between two groups before treatment and 30 d after treatment（P ＞ 0.05）.In both two groups,the BNP concentration and E/A were significantly reduced and LVEF and CI significantly rised 30 d after treatment （P ＜ 0.05）.The incidence of MACE was significantly lower in observation group than in control group.Conclusion Isosorbide dinitrate can effectively improve the heart function in patients accompanied with acute STEMI who receive primary PCI and reduce the incidence of MACE 30 d after treatment.