围术期应用rhBNP对STEMI患者急诊PCI术中无复流-慢血现象、炎性因子和心功能的影响

Effects of application of lyophilized recombinant human brain natriuretic peptide( rh-BNP) before emergency PCI on no reflow phenomenon,inflammatory factors and cardiac function in patients with acute ST segment elevation myocardial infarction

目的探讨急诊经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者围术期给予静脉冻干重组人脑利钠肽(rh-BNP),观察介入术中无复流-慢血流发生的风险、炎性因子及心功能变化水平。方法选取99例行急诊PCI治疗的患者(发病时间<12 h),术前均给予阿司匹林、氯吡格雷、阿托伐他汀负荷量处理,随机分为研究组(急诊PCI治疗+冻干重组rh BNP,n=51)和对照组(单纯急诊PCI治疗,n=48)。观察2组在急诊PCI治疗中TIMI血流分级、TIMI心肌灌注分级(TMPG)情况,判定无复流现象发生的情况,以及术前、术后1周、术后30 d前体脑钠肽(NT-Pro BNP)、高敏C-反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)水平的变化;观察2组术后1周、4周、3个月的左室射血分数(LVEF)、左心室收缩末容积指数(LVESVI)、室壁运动积分指数(WMSI)。结果 2组手术成功率均为100%。研究组无复流发生率明显低于对照组(P<0.05),TIMI血流分级Ⅲ级所占比例明显高于对照组(P<0.05),TMPG3级的比例明显高于对照组(P<0.05)。2组治疗1周和术后30 d后,NTpro BNP、CRP、TNF-α、IL-6水平均明显下降(P<0.01),且研究组较对照组于术后1周及术后30 d均明显下降(P<0.05)。2组患者术后随时间推移(术后1周、术后4周、术后3个月)LVEF水平递升,LVESVI、WMSI水平递降,至术后3个月时与术后1周比较差异均有统计学意义(P<0.05);且研究组各时点LVEF较对照组有所提高,LVESVI、WMSI水平不同程度地低于对照组,至术后3月时差异均有统计学意义(P<0.05)。结论急性ST段抬高性心肌梗死患者直接PCI围术期前应用BNP可有效改善缺血心肌的再灌注,预防术中无复流,改善心功能和临床预后。

Objective To investigate the effects of application of lyophilized recombinant human brain natriuretic peptide（ rh-BNP） before emergency PCI on no reflow phenomenon,inflammatory factors and cardiac function in patients with acute ST segment elevation myocardial infarction（ STEMI）. Methods A total of 99 patients with STEMI（ onset time 12 hours） who underwent emergency PCI in our hospital from 2013 to 2016 were enrolled in the study. The patients were randomly divided into two groups： research group（ n = 51） and control group（ n = 48）. The patients in research group were treated by emergency PCI ＋ rh-BNP,however,the patients in control group were treated by emergency PCI only. The thrombolysis in myocardial infarction（ TIMI） blood flow grading during PCI,TIMI myocardial perfusion grading（ TMPG）,the changes of N terminal B type natriuretic peptide（ NT-pro BNP） levels,the plasma levels of high-sensitivity C-reactive protein（ hs-CRP）,tumor necrosis factor-α（ TNF-α）,interleukin-6（ IL-6） before operation,on 1 w,30 d after operation were observed,moreover,the left ventricular ejection fraction（ LVEF）,left ventricular end-systolic volume index（ LVESVI） and wall motion score index（ WMSI） were observed and compared between two groups. Results The surgery success rate was100% in both groups. The incidence rate of no reflow in research group was significantly lower than that in control group（ 15. 68% vs 33. 33%,P〈0. 05）. The proportion of the grade Ⅲ of TIMI blood flow grading in research group was significantly higher than that in control group（ 84. 32% vs 66. 67%,P〈0. 05）,moreover,the proportion of grade 3 of TMPG was significantly higher than that in control group（ 74. 50% vs 45. 83%,P〈0. 05）. In addition,the plasma levels of NTpro BNP,hs-CRP,TNF-α and IL-6 on 1 w,30 d after operation were significantly decreased in both groups（ P〈0. 01）,moreover,the levels of these indexes in research group were significantly lower than those in control group（ P〈0. 05）. The levels of LVEF were increased gradually with the time going on 1 w,4 w,3 m after operation in both groups,however,the levels of LVESVI,WMSI were decreased gradually with the time going on,moreover,there were significant differences in the levels between 3 m after operation and 1 w after operation in both two groups（ P〈0. 05）. As compared with those in control group in every time point,the levels of LVEF were increased at certain degree and the levels of LVESVI and WMSIwere decreased in research group,there were significant differences in the levels on 3 m after operation between two groups（ P〈0. 05）. Conclusion The application of BNP before PCI can effectively improve the reperfusion of ischemic myocardium of patients with STEMI,prevent intraoperative no reflow and improve cardiac function and clinical prognosis.