前列地尔对改善急性心肌梗死PCI术后无复流现象的疗效观察

The curative efficacy of alprostadil on the improvement of no-reflow after PCI operation in patients with acute myocardial infarction

目的探讨前列地尔对急性心肌梗死患者介入治疗术后慢血流及无再流的影响。方法选择我院救治的急性心肌梗死患者65例,全部为经皮冠脉支架植入术中出现慢血流及无再流病例,随机分为硝酸甘油组和前列地尔组。术中出现无再流或慢血流后,硝酸甘油组单纯冠脉内注射硝酸甘油;前列地尔组在给予硝酸甘油的基础上,冠脉内注射前列地尔。评价两组患者术中术后血管血流变化情况,不同时间点心电图、心肌酶学、心功能变化。结果前列地尔组术后血管TIMI分级3级发生率明显高于对照组;24 h内不同时间点血清CK、CK-MB、LDH水平持续下降,且下降幅度优于单纯硝酸甘油组;24 h内心电图ST段回落幅度及回落指数优于硝酸甘油组;6个月后,前列地尔组LVEF增加及LVEDV减少幅度明显优于冠脉内单用硝酸甘油组,差异均有统计学意义(P<0.05)。结论 PCI治疗后无复流患者冠脉内联合应用前列地尔和硝酸甘油可明显改善缺血心肌的微循环,逆转无复流,增加冠脉血流量,改善心肌代谢,避免心肌缺血和再灌注损伤,改善心功能。

Objective To investigate the effect of Alprostadil on the slow and no-reflow phenomena in patients with AMI after PCI. Methods Sixty-five patients with Acute Myocardial Infarction （AMI） who experienced slow and no-reflow phenomenon during PCI operation were enrolled and randomized into Nitroglycerin group and Alprostadil group. After the slow or no-reflow phenomenon during the operation occurred , patients in the nitroglycerin group were given intraeoronary nitroglycerin alone, patients in the alprostadil group were given intraeoronary injection of alprostadil on the basis of nitroglycerin. The changing situation of the blood flow in the vascular during and after the operationinwere assessed at different time points, as well as the ECG, myocardial enzymes and cardiac function. Results The incidence of postoperative blood flowto TIMI 3 in vessels in Alprosta- dil group was significantly higher than that in the control group.Serum levels of CK, CK-MB and LDH continuously declined within 24 h, and the extent of decline was superior than that in the Nitroglycerin group. The ST interval drop and fall index within 24 h in ECG was better than that in the Nitroglycerin group.Afler 6 months, the increase of LVEF and the decrease of LVEDV in the Alprostadil group were significantly superior than those in the group received nitroglycerin into coronary alone （P 〈 0.05 ）. Conclusion Intraeoronary combination withalprostadil and nitroglycerin could significantly improve the microeireulation of isehemie myoeardium in patients with slow and no-reflow after PCI, reversing no-reflowphenomenon, increasing intraeoronary blood flow, improving myocardial metabolism, preventing myocardial isehemia and reperfusion injury and increasing heart function.