重组人脑利钠肽对老年急性心肌梗死患者经皮冠状动脉介入治疗后心功能及组织灌注的影响

Effect of recombinant human brain natriuretic peptide on cardiac function and tissue perfusion after PCI in elderly patients with acute myocardial infarction

目的探讨重组人脑利钠肽对老年急性心肌梗死患者经皮冠状动脉介入(PCI)治疗后心功能及组织灌注的影响。方法选取2015年9月至2017年2月在开封市中心医院住院治疗的急性心肌梗死且行PCI手术的老年患者96例,按照随机数字表法分为对照组和观察组,每组各48例。对照组患者采用急性心肌梗死的常规疗法,观察组患者在常规疗法基础上应用重组人脑利钠肽。术后6个月,比较两组患者心肌组织灌注水平、心功能[左心室舒张期末内径(LVEDd)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、舒张早期与晚期最大血流比(E/A)、左心室重量指数(LVMI)、左心室射血分数(LVEF)]以及主要的心脏不良事件情况。结果心脏相关指标:治疗后,观察组患者的心脏指数高于对照组[(4.12±0.34)vs(3.68±0.43)],观察组患者的乳酸水平及N端前脑钠肽(NT-pro BNP)水平均低于对照组[(2.51±0.34)mmol/L vs(3.42±0.52)mmol/L;(14.72±5.21)ng/m L vs(18.14±4.32)ng/m L],差异均有统计学意义(P<0.05)。心肌组织灌注水平:治疗后,观察组患者的TIMI分级3级比例高于对照组,观察组患者TIMI帧数(CTFC)低于对照组[(27.62±4.74)vs(37.34±5.11)],差异均有统计学意义(P<0.05)。心功能指标:治疗后,两组患者的LVEDd差异无统计学意义(P>0.05),观察组患者的IVST、LVPWT、LVMI低于对照组,E/A、LVEF高于对照组,差异均有统计学意义(P<0.05)。心脏不良事件:术后6个月,观察组患者发生严重心力衰竭比例低于对照组[2.08%vs20.83%],差异有统计学意义(P<0.05)。结论在常规治疗基础上将重组人脑利钠肽应用于老年急性心肌梗死患者PCI术后,有助于心脏功能和组织灌注水平进一步改善,值得临床推广。

Methods A total of 96 elderly patients with acute myocardial infarction hospitalized for PCI in our hospital from Sept 2015 to Feb 2017 were selected. According to the random number table method, they were divided into control group and observation group, with 48 cases in each group. The patients in control group were treated with routine therapy of acute myocardial infarction, and those in observation group with recombinant human brain natriuretic peptide on the basis of routine therapy. Cardiac function [ left ventricular end - diastolic diameter （LV EDd） , interventricular septal thickness （IV STT） , left ventricular posterior wall thickness （LVPWTT） , early to late diastolic maximal blood flow ratio （E / A）,left ventricular mass index （L V MI）,left ventricular ejection fraction （LV EF） ] and major adverse cardiac events were compared. Results Heart related indexes： after treatment, the cardiac index of the patients in observation group was 4.1 2 ± 0 .3 4 jjl g / mL, which was higher than that in control group （3 .6 8 ± 0 .4 3 ）. The lactate level of the patients in observation group was 2 .51 ± 0 .3 4） mmol / L and the N - terminal brain natriuretic peptide （ NT - proBNP） level was 14. 72 ± 5. 2 1 ） ng / mL, which was significantly lower than that in control group （3？ 42 ± 0 .5 22 mmol / L and 18.14 ±4.3 2 ng/mL,P 〈 0 .0 5） ？ Myocardial perfusion： After treatment, the ra- tio of TIMI grade 3 in observation group was higher than that of control group. The TIMI frame number （ GTFC） （2 7.6 2 ±4.74） was lower in observation group than in control group （37. 34 ±5.1 1 ）,and the difference was statistically significant （P 〈 0 ？ 0 5）. Cardiac function in-dex： after treatment, there was no significant difference in LVEDd between the two groups. The IVST, LVPWT, LVMI in observation group was lower than that in control group. E/A and LVEF in observation group was higher than that in control group, and the difference was statis-tically significant （ P 〈 0. 05 ） . Adverse cardiac events ： six months after operation, the incidence of severe heart failure in observation group was 2 . 08% , lower than that in control group （20 . 83% , P 〈 0 . 0 5）. Conclusion The application of recombinant human brain natriuretic peptide on the basis of routine therapy in elderly patients with acute myocardial infarction after PCI is beneficial to the improvement of cardiac function and tissue perfusion.