苦碟子注射液联合别嘌醇预处理对经皮冠状动脉介入治疗围手术期心肌损伤及血管内皮功能的影响

Effect of Kudiezi injection combined with allopurinol preconditioning on perioperative myocardial injury and vascular endothelial function after percutaneous coronary intervention

目的观察苦碟子注射液联合别嘌醇预处理对经皮冠状动脉介入(PCI)治疗围手术期患者心肌损伤及血管内皮功能的影响。方法将150例拟择期行PCI治疗的患者随机分为观察组75例和对照组75例,2组入院后均给予冠心病标准化治疗,对照组在PCI术前3 d给予别嘌醇顿服(300 mg/d);观察组在对照组基础上给予给予苦碟子注射液治疗40 mL静滴(1次/d),手术当天置入导管前再静推20 mL。检测2组PCI术前及术后8 h、24 h的血浆肌钙蛋白Ⅰ(cT nI)、肌酸激酶同工酶(CK-MB)、氨基末端B型利钠肽前体(NT-proB NP)、超敏C反应蛋白(hs-CRP)水平及血浆内皮素-1(ET-1)、血管性假血友病因子(vW F)、一氧化氮(NO)和血流依赖性舒张功能(FMD),记录cT nI和CK-MB阳性率以及术后8 h、24 h之内的再灌注心律失常发生情况。结果 2组术后8 h、24 h血浆cT nI、CK-MB、NTproB NP、hs-CRP、ET-1、vW F水平均显著升高(P均<0.05),但观察组各指标水平均明显低于对照组(P均<0.05);NO、FMD均明显降低(P均<0.05),但观察组各指标水平均高于对照组(P均<0.05);观察组术后8 h、24 h的cT nI和CK-MB阳性率及再灌注心律失常总发生率均低于对照组(P均<0.05)。结论在PCI术前给予别嘌醇预处理的基础上,联合苦碟子注射液治疗能够减轻围手术期心肌损伤程度,降低再灌注心律失常发生率,其机制可能与抑制炎性反应、保护血管内皮细胞功能有关。

Objective It is to observe the effect of Kudiezi Injection and allopurinol preconditioning on myocardial injury and vascular endothelial function in perioperative patients undergoing percutaneous coronary intervention( PCI). Methods A total of 150 patients scheduled for PCI were randomly divided into observation group( n = 75) and control group( n =75). Both groups were given standardized treatment of coronary heart disease after admission. The control group was given allopurinol 300 mg/d administered at draught at 3 days before PCI operation. The observation group was given Kudiezi injection 40 m L by intravenous drip( once a day) on the basis of the control group,and 20 m L was given before catheterization on the day of operation. Plasma levels of c Tn I,CK-MB and NT-pro BNP,hs-CRP,ET-1,v WF,NO and FMD were measured before and 8 h and 24 h after PCI in both groups,the positive rate of c Tn I and CK-MB and the incidence of reperfusion arrhythmia within 8 h and 24 h after operation were recorded. Results The plasma levels of c Tn I,CK-MB,NTpro BNP,hs-CRP,ET-1 and v WF were significantly increased at 8 h and 24 h after operation in both groups( P < 0. 05),but the levels of these indexes in the observation group were significantly lower than those in the control group( P < 0. 05);The levels of NO and FMD were significantly decreased in both groups at 8 h and 24 h after operation,and the levels of NO and FMD in the observation group were significantly higher than those in the control group( all P < 0. 05). The overall incidence of reperfusion arrhythmia and the positive rate of CK-MB and c Tn I were lower in the observation group were significantly lower than those in the control group( all P < 0. 05). Conclusion On the basis of pre-treatment of allopurinol before PCI,combination with Kudiezi injection can reduce perioperative myocardial injury and reduce the incidence of reperfusion arrhythmia,the mechanism may be related to inhibition of inflammatory response and protection of blood vessels endothelial cell function.