前列地尔对改善急性心肌梗死PCI术后微循环及患者预后的影响

Influence of alprostadil on improving the microcirculation after direct percutaneous coronary intervention and the outcomes of patients with acute myocardial infarction

目的:探讨前列地尔治疗急性心肌梗死经皮冠状动脉介入术(PCI)治疗后微循环障碍以及改善患者预后的临床效果。方法:将57例因ST段抬高型急性心肌梗死接受急诊PCI的患者随机分为2组,前列地尔组在术前30 min使用前列地尔注射液治疗,并在术后继续治疗7 d。通过检测校正的TIMI帧数计数(CTFC)、心肌声学造影(MCE)等多种方法评估心肌灌注,并观察患者在住院和随访期间心功能情况及主要心脏不良事件。结果:前列地尔组术后的TIMI 3级血流发生率明显高于对照组(P=0.038),术后CTFC值也较对照组明显升高(P<0.001);在治疗6个月后前列地尔组的左室射血分数(LVEF)、舒张早期充盈最大速率(E峰)与心房收缩期最大充盈速率(A峰)的比值(E/A)、左室舒张末期内径(LVEDD)以及左室收缩末期内径(LVESD)均较治疗3 d后有明显改善(P均<0.05),而室间隔厚度(IVST)以及左室后壁舒张末期厚度(LVPWD)则无明显变化;两组患者PCI术后48 h、术后7 d的MCE显示,前列地尔组的局部心肌血流量在术后7 d有显著升高(P<0.05)。对照组在住院和随访期间发生6例严重心力衰竭以及1例死亡病例,前列地尔组在住院期间发生严重心力衰竭1例,在随访期间发生严重心力衰竭1例,无死亡病例,两组比较无统计学差异。结论:前列地尔可以有效地改善PCI术后的心脏血流灌注,减少无复流现象的发生,可能改善急性心肌梗死患者心功能及临床预后。

Objective：To investigate the clinic effect of alprotadil on improving the microcirculation after percutaneous coronary intervention（PCI）and the outcomes of patients with acute myocardial infarction（AMI）. Methods：A total of 57 patients with ST segment elevation myocardial infarction received emergency PCI were selected in clinical research and divided in two groups：control group（n=30）and alprostadil group（n=27）.Both groups were given basic treatments of coronary atherosclerotic heart disease.In alprostadil group,alprostadil was intravenously injected for 10μg at 30 min before coronary angiography and continuously once a day for 7 d after PCI.Corrected TIMI frame count（CTFC）, myocardial contrast echocardiography（MCE） were applied to evaluate the myocardial perfusion.Major adverse cardiac events and cardiac function measured by color Doppler ultrasonic cardiogram were observed during hospitalization and follow-up. Results：TIMI grade 3 occurred more frequently in alprostadil group compared with control group（P=0.038）.The CTFC after PCI also differed in two groups（P0.001）.Compared to 3rd days after treatment,left ventricular end diastolic dimension（LVEDD）and left ventricular end systolic dimension（LVESD）were found significantly improved while left ventricle ejection fraction（LVEF）,ratio of the early（E）to late（A）ventricular filling velocities（E/A）were found significantly improved in alprostadil treatment group after 6 months treatment（all P0.05）.However,there was no significant change in interventricular septal thickness（IVST）and left ventricular posterior wall dimension（LVPWD）.A×βmeasured by MCE quantification defined as localized myocardial blood flow showed increased at 7 d after PCI compared to 48 h after PCI（P0.05）.6 cases of severe heart failure and 1 case of death was observed during hospitalization and follow-up visit in control group while adprostadil treatment group had each 1 case of severe heart failure during hospitalization and follow-up visit.Two groups had no statistical significance. Conclusion：Alprostadil can effectively improve the myocardial perfusion after PCI,reduce no-reflow phenomenon,and improve the cardiac function and clinical outcomes in patients with AMI.