乌司他丁联合环磷腺苷葡胺治疗急性心肌梗死的临床研究

Clinical study of ulinastatin combined with meglumine adenosine cyclophosphate in treatment of acute myocardial infarction

目的探讨乌司他丁联合环磷腺苷葡胺治疗急性心肌梗死的临床疗效。方法选取2016年6月—2017年6月在哈尔滨医科大学附属第二医院进行治疗的急性心肌梗死患者74例,随机分为对照组(37例)和治疗组(37例)。对照组患者静脉滴注注射用环磷腺苷葡胺,180 mg加入5%葡萄糖注射液250 mL,1次/d。治疗组在对照组的基础上静脉滴注乌司他丁注射液,100 000 U加入5%葡萄糖注射液500 mL,每次持续1~2 h,2次/d。两组患者均经过2周治疗。观察两组患者临床疗效和心电图疗效,比较治疗前后两组患者心绞痛发作次数、心绞痛持续时间、心功能指标、血清学指标和神经内分泌激素水平。结果治疗后,对照组和治疗组临床总有效率分别为81.08%和94.59%,两组比较差异具有统计学意义(P<0.05)。治疗后,对照组和治疗组心电图有效率分别为70.27%和91.89%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者心绞痛发作次数和持续时间均显著减少(P<0.05);且治疗组患者心绞痛发作次数和持续时间显著少于对照组(P<0.05)。治疗后,两组每博量(SV)、心博量(CO)、左心室射血分数(LVEF)水平均明显升高(P<0.05);且治疗组患者心功能指标明显高于对照组(P<0.05)。治疗后,两组血清患者C反应蛋白(hs-CRP)、心肌肌钙蛋白(cTnⅠ)、磷酸肌酸激酶(CK)和氨基末端脑钠肽前体(NT-proBNP)水平均显著降低(P<0.05);且治疗组患者上述血清学指标明显低于对照组(P<0.05)。治疗后,两组患者血清去甲肾上腺素(NE)、肾素活性(PRA)、β内啡肽(β-EP)、血管紧张素II(Ang II)水平均显著降低(P<0.05);且治疗组患者的神经内分泌激素水平显著低于对照组(P<0.05)。结论乌司他丁联合环磷腺苷葡胺治疗急性心肌梗死可有效改善患者心功能,保护受损心肌细胞,降低机体炎症反应和神经内分泌激素水平。

Objective To explore the clinical efficacy of ulinastatin combined with meglumine adenosine cyclophosphate in treatment of acute myocardial infarction. Methods Patients（74 cases） with acute myocardial infarction in the 2 nd Affiliated Hospital of Harbin Medical University from June 2016 to June 2017 were randomly divided into control（37 cases） and treatment（37 cases） groups. Patients in the control group were iv administered with Meglumine Adenosine Cyclophosphate for injection, 180 mg added into 5% Glucose Injection 250 mL, once daily. Patients in the treatment group were iv administered with Ulinastatin Injection on the basis of the control group for 1 — 2 h, 1×105 U added into 5% Glucose Injection 500 mL, twice daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacy and ECG efficacy were evaluated, the frequency and duration of angina attack, cardiac function indexes, serological indexes, and neuroendocrine hormones in two groups before and after treatment were compared. ResultsAfter treatment, the clinical efficacy in the control and treatment groups were 81.08% and 94.59%, respectively, and there were differences between two groups（P〈0.05）. After treatment, the ECG efficacy in the control and treatment groups were 70.27% and 91.89%, respectively, and there were differences between two groups（ P〈0.05）. After treatment, the frequency and duration of angina attack in two groups were significantly decreased（P〈0.05）. And the frequency and duration of angina attack in the treatment group were significantly less than that in the control group（P〈0.05）. After treatment, the SV, CO, and LVEF levels in two groups were significantly increased（P〈0.05）. And the cardiac function indexes in the treatment group were significantly higher than those in the control group（P〈0.05）. After treatment, the hs-CRP, cTnⅠ, CK and NT-proBNP levels in two groups were significantly decreased（P〈0.05）. And the serological indexes levels in the treatment group were significantly lower than those in the control group（P〈0.05）. After treatment, the NE, PRA, β-EP and Ang II levels in two groups were significantly decreased（P〈0.05）. And the neuroendocrine hormones levels in the treatment group were significantly lower than those in the control group（P〈0.05）. Conclusion Ulinastatin combined with meglumine adenosine cyclophosphate can effectively improve the cardiac function and protect the damaged myocardial cell in treatment of acute myocardial infarction, which also reduce the inflammatory response and neuroendocrine hormone levels.