急性心肌梗死合并急性心力衰竭患者再灌注后2小时应用西地兰对心脏胶原代谢的影响

Prognostic impact of cedilanid administration after early reperfusion 2h on collagen metabolism in acute myocardial infarction complicated with acute heart failure patients

目的观察急性心肌梗死(AMI)合并急性心力衰竭(AHF)患者发病24h内接受经皮冠状动脉介入治疗(PCI)2h应用西地兰治疗后心功能及胶原代谢的变化。方法选择2017年1月至2018年1月期间在广州市花都区人民医院接受PCI治疗的AMI合并AHF患者93例,随机分为观察组(n=48例)和对照组(n=45例)。对照组患者于再灌注治疗后予以0.9%20mL的氯化钠注射液匀速注射,观察组患者于再灌注治疗予以0.2mg洋地黄+0.9%20mL氯化钠注射液匀速注射。比较两组患者用药前后血流动力学指标[肺毛细管楔压(PCWP)、心脏指数(CI)、每搏输出量(SV)]、实验室生化指标[肌酸激酶同工酶(CK-MB)、肌红蛋白(Myo)、肌钙蛋白(cTnI)、B型脑钠肽(BNP)]、心功能[左室射血分数(LVEF)、短轴缩短率(FS)]和胶原代谢指标[Ⅰ型C端胶原前肽(PⅠCP)及Ⅲ型N端胶原前肽(PⅢNP)]的差异。结果①血流动力学指标变化:两组患者再通后,CI、SV呈升高趋势,PCWP呈下降趋势,不同时间点两组比较差异均有统计学意义(P<0.05);②超声心动图指标变化:两组患者再通后,LVEF和FS呈升高趋势,不同时间点两组比较差异均有统计学意义(P<0.05)。用药后3h和24h,观察组患者LVEF值分别为(50.48±4.79)%和(54.08±5.12)%,FS值分别为(26.85±4.08)%和(28.45±3.97)%,均高于对照组患者(P<0.05);③血液生化指标变化:用药24h后,两组患者血CK-MB、Myo、cTnI及BNP水平均较用药前有所降低(P<0.05),同时观察组患者Myo水平和BNP含量分别为(982.46±458.51)ng/mL和(460.61±154.95)ng/mL,均高于对照组患者(769.59±346.38)ng/mL和(381.57±118.34)ng/mL(P<0.05);④胶原代谢指标变化:用药24h后,两组患者PⅠCP水平均较用药前有所升高(P<0.05),同时观察组患者PⅠCP和PⅢNP含量分别为(24.57±7.34)ng/mL和(2.68±1.51)ng/mL,明显低于对照组患者(32.64±8.29)ng/mL和(7.26±1.59)ng/mL(P<0.05)。结论AMI合并AHF患者行早期再灌注后,在常规治疗的基础上早期静脉推注小剂量西地兰可改善患者左室收缩功能,安全性良好。

Objective To observe the clinical efficacy and safety of cedilanid administration after early percutaneous coronary intervention(PCI)2 h on left ventricular remodeling and collagen metabolism in acute myocardial infarction complicated with acute heart failure(AMI-AHF)patients.Methods A total of 93 AMI-AHF patients in our hospital from January 2017 to January 2018 were selected and randomly divided into observation group(Cedilanid 0.2 mg + 0.9% saline 20 mL,n=48)and control group(0.9% saline 20 mL,n=45).The hemodynamic parameters,such as pulmonary capillary wedge pressure(PCWP),cardiac index(CI)and stroke volume(SV)were monitored.The left ventricular ejection fraction(LVEF)and short axial shortening rate(FS)were measured by doppler echocardiography.The levels of plasma creatine kinase isoenzyme(CK-MB),myoglobin(Myo),cardiac troponin I(cTnI),B type natriuretic peptide(BNP),carboxy-terminal propeptide of type Ⅰ collagen(PⅠCP)and aminoterminal propeptide of type Ⅲ collagen(PⅢNP)were detected by kits.Results ①Changes of hemodynamic indicators:the indicators of CI,SV increased,PCWP declined after reperfusion,which were significantly obvious between the groups at different time(P<O.05).(2)Changes of echocardiography indexes:the indicators of LVEF and FS increased after PCI.LVEF [(50.48 ±4.79)% and(954.08 ±5.12)%] and FS [(26.85 ±4.08)% and(28.45 ± 3.97)%] of observation group were obviously higher than control group at different times after medication of 3 h and 24 h(P<0.05).③Changes of plasma level:the levels of CK-MB,Myo,cTnI and BNP in both observation and control groups were lower than before administration at medication of 3 h and 24 h(P<0.05).And the levels of Myo[(982.46 ± 458.51)ng/mL] and BNP [(460.61 ± 154.95)ng/mL] in observation group were a little higher than control group(P<0.05).④Changes of collagen metabolism indexes:the levels of PⅠCP in both observation and control groups were higher than before administration at medication of 24 h(P<0.05).And the levels of PⅠ CP [(24.57 ± 7.34)ng/mL] and PⅢ NP [(2.68 ±1.51)ng/mL] in observation group were lower than control group(P<0.05).Conclusion Early application of cedilanid can improve the left ventricular systolic function and collagen metabolism,It is a safe and effective treatment for reperfused AMI-AHF patients.