院前瑞替普酶溶栓治疗对急性心肌梗死患者心脏结构及心功能的影响

Influence of pre- hospital reteplase thrombolytic therapy on cardiac structureand function of patients with acute myocardial infarction

目的探讨院前早期溶栓治疗对急性心肌梗死患者心脏结构及心功能的影响。方法选取2组诊断明确的急性心肌梗死患者,分别于院前及院内给予相同治疗方案的瑞替普酶溶栓治疗,分别测定就诊即刻,12、24、72 h以及7 d的血浆氨基末端脑钠肽前体(NT-pro BNP)浓度,另测定就诊即刻,1周,3、6个月和1年左心室舒张末内径(LVEDD)、左心室收缩末内径(LVESD)、左心室射血分数(LVEF)。结果就诊即刻2组血浆NT-pro BNP浓度比较,差异无统计学意义(P>0.05);就诊12、24、72 h及7 d比较,院内溶栓组较院前溶栓组血浆NT-pro BNP浓度升高,差异有统计学意义(P<0.05)。LVEDD、LVESD、LVEF方面,院前溶栓组和院内溶栓组3、6个月和1年LVEDD、LVESD、LVEF比较,差异有统计学意(P<0.05)。结论院前瑞替普酶溶栓治疗可改善急性心肌梗死患者的心脏重塑,保护心功能。

Objective To explore the influence of pre- hospital thrombolytic therapy on cardiac structure and function of patients with acute myocardial infarction. Methods Patients with diagnosed acute myocardial infarction were selected and divided into two groups,and the patients in the two groups were respectively treated with the same thrombolytic therapy before hospital admission and after hospital admission. Level of NT- pro BNP was detected at the time points of on hospital admission,12,24 and 72 hours and 7 days after hospital admission in both groups. Levels of LVEDD LVESD,LVEF were detected at the time points of on hospital admission,one week,3 and 6 months and 1 year after hospital admission in both groups. Results There was no significant difference of NT- pro BNP level on hospital admission between two groups（ P 0. 05）. NT- pro BNP levels at the time points of 12,24 and 72 hours and 7 days after hospital admission in intra- hospital thrombolytic group were significantly higher than those in pre- hospital thrombolytic group（ P 0. 05）. There were significant differences in LVEDD LVESD,LVEF levels at the time points of 3 and 6 months and1 year after hospital admission between intra- hospital thrombolytic group and pre- hospital thrombolytic group（ P 0. 05）. Conclusion Pre- hospital thrombolytic therapy can improve cardiac remodeling and protect cardiac function in patients with acute myocardial infarction.