小剂量多巴胺联合生脉丹参补血方对NSTEMI并发1型心肾综合征患者心肌损伤标记物、肾血流灌注和心肾功能的影响

Effects of low-dose dopamine combined with Shengmai Danshen Buxue decoction on myocardial injury markers, renal perfusion and cardiac and renal function in patients with NSTEMI complicated with type 1 cardio-renal syndrome

目的观察小剂量多巴胺联合生脉丹参补血方对急性非ST段抬高型心肌梗死(NSTEMI)并发1型心肾综合征(CRS)患者心肌损伤标记物、肾血流灌注和心肾功能的影响。方法将80例NSTEMI并发1型CRS患者随机分为观察组和对照组各40例,2组均接受心内科常规治疗,对照组同时给予小剂量多巴胺静脉泵入治疗,观察组在对照组基础上给予生脉丹参补血方治疗,疗程均为7d。观察2组治疗前后心电图、心肌梗死killip分级、心肌损伤标记物、肾血流灌注和心肾功能的变化。结果与治疗前比较,2组治疗后ST段压低幅度、ST段压低导联数目、T波倒置深度及血浆肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、肌酸激酶(CK)、肌红蛋白(Mb)、血肌酐(SCr)、血尿素氮(BUN)水平均较治疗前明显降低(P均<0.05),心肌梗死killip分级情况均较治疗前明显改善,左室射血分数(LVEF)、左室缩短分数(LVFS)均明显增高(P均<0.05),左室舒张末期内径(LVEDD)、左室收缩末期内径(LVSDD)均明显缩短(P均<0.05),肾内段动脉、叶间动脉的收缩期峰值流速(PSV)均明显增快(P均<0.05),阻力指数(RI)均明显降低(P均<0.05),尿量、估算肾小球滤过率(eGFR)均明显增加(P均<0.05),观察组治疗后以上指标改善情况均明显优于对照组(P均<0.05)。结论小剂量多巴胺联合生脉丹参补血方对可显著改善NSTEMI并发1型CRS患者心肌缺血损害及肾血流灌注,具有显著的心肾功能保护效应。

Objective It is to observe the effect of low-dose dopamine combined with Shengmai Danshen Buxue decoction on myocardial injury markers, renal perfusion and heart and kidney function in patients with acute non-ST-segment elevation myocardial infarction(NSTEMI) complicated with type 1 cardio-renal syndrome(CRS). Methods Ninety patients with NSTEMI complicated with type 1 CRS were randomly divided into observation group(40 cases) and control group(40 cases). Both groups were treated with routine therapy of cardiology department. The control group was given low-dose dopamine by intravenous pumping, and the observation group was given Shengmai Danshen Buxue decoction based on the control group. Both groups were treated for 7 days. The changes of electrocardiogram, killip classification of myocardial infarction, myocardial injury markers, renal perfusion and cardiac and renal function were observed before and after treatment in the two groups. Results The ST segment depression amplitude, numbers of ST segment depression leads, T wave inversion depth and the levels of plasma troponin I(cTnI), creatine kinase isoenzyme(CK-MB), creatine kinase(CK), myoglobin(Mb), serum creatinine(SCr) and blood urea nitrogen(BUN) were significantly lower than those before treatment in the two groups(P<0.05). The killip classification of myocardial infarction was significantly improved, left ventricular ejection fraction(LVEF) and left ventricular fissure fraction(LVFS) were significantly increased(P<0.05), left ventricular end-diastolic diameter(LVEDD) and left ventricular end-systolic diameter(LVSDD) were significantly shortened(P<0.05), the peak systolic velocity(PSV) of intrarenal artery and interlobular artery was significantly increased(P<0.05), and the resistance index(RI) was significantly decreased(P<0.05), urine volume, estimated glomerular filtration rate(eGFR) was significantly increased(P<0.05) compared with that before treatment. The improvement of the above indicators in the observation group was significantly better than that in the control group(P<0.05). Conclusion Low-dose dopamine combined with Shengmai Danshen Buxue decoction can significantly improve myocardial ischemic injury and renal perfusion in patients with NSTEMI complicated with type 1 CRS, and has significant protective effect on heart and kidney function.