重组人脑钠肽在急性心肌梗死患者急诊冠状动脉介入术后的应用效果

Application effect of recombinant human brain natriuretic peptide on patients with acute myocardial infarction after primary percutaneous coronary intervention

目的探讨急诊冠状动脉介入(p-PCI)术后应用重组人脑钠肽(rhBNP)对急性心肌梗死患者心室重构的影响。方法 83例急性ST段抬高型心肌梗死患者于发病12 h内接受p-PCI,其中对照组44例术后给予常规治疗,治疗组39例术后常规治疗加静脉注射rhBNP。术前检测两组患者血浆人脑钠肽(BNP)水平;术后24 h内及6个月行超声心动图检测,测定左室射血分数(LVEF)、左心室舒张末期容积(LVEDV);记录术后6个月内不良心血管事件的发生率。结果两组术前BNP水平比较,差异无统计学意义(P>0.05)。与术后24 h内相比,两组术后6个月的LVEF增高、LVEDV降低(P<0.01);术后6个月,治疗组LVEF较对照组高LVEDV较对照组减低(P<0.05)。治疗组不良心血管事件的发生率低于对照组(P<0.05)。结论 p-PCI术后早期应用rhBNP可改善急性心肌梗死患者的心室重构,且不良心血管事件发生率较低。

Objective To explore the effect of recombinant human brain natriuretic peptide （rhBNP） on cardial remodeling after primary percutaneous coronary intervention （p-PCI） in patients with acute myocardial infarction. Methods Eighty-three patients with acute ST segment elevation myocardial infarction underwent p-PCI within 12 hours after attack, and were divided into treatment group （ n = 39） and control group（n =44）. Control group was given routine therapy after p-PCI,while treatment group was administered intravenously rhBNP after p-PCI besides routine therapy. The plasma levels of brain natriuretic peptide（BNP） were detected in both groups before p-PCI ,and echocardiography was conducted for the measurement of left ventricular ejection fraction（LVEF） and left ventricular end-diastolic volume （LVEDV） within 24 hours after p-PCI and after 6 months of p-PCI. The incidence of main adverse cardiovascular events（MACE） within 6 months after p-PCI was recorded. Results There was no significant difference in the BNP level between two groups before p-PCI （P 〉 0.05 ）. For two groups,LVEF increased and LVEDV decreased after 6 months of p-PCI compared to these indices within 24 hours after p-PCI （ P 〈 0.01 ）. After 6 months of p-PCI, treatment group obtained higher LVEF and lower LVEDV compared to control group（P 〈 0.05 ）. The incidence of MACE of treatment group was lower than that of control group （ P 〈 0 05 ）. Conclusion The application of rhBNP in early stage after p-PCI can improve the cardial remodeling of patients with acute myocardial infarction, and has lower incidence of MACE.