肾上腺素治疗对AMI介入手术患者灌注水平及血管内皮功能损伤的改善作用研究

Effect of adrenaline on the perfusion level and vascular endothelial injury in patients undergoing AMI intervention

目的探讨冠脉内注射肾上腺素对急性心肌梗死(AMI)经皮冠脉介入(PCI)治疗患者心肌再灌注及血管内皮功能的影响。方法选取实施PCI手术治疗后出现慢血流的98例AMI患者,采用随机数字表法分为试验组和对照组各49例,试验组术后冠脉内注射肾上腺素,对照组冠脉内给予等量生理盐水;对比两组患者的冠脉血流(TIMI)分级变化、校正的TIMI血流帧幅数(CTFC),治疗前后患者血清基质金属蛋白酶9(MMP-9)、髓过氧化物酶(MPO)、超敏C反应蛋白(hs-CRP)、血浆内皮素-1(BT-1)、血小板内皮细胞黏附分子(PECAM-1)、一氧化氮(NO)、氨基末端脑钠肽前体(NT-proBNP)、肌钙蛋白T(cTnl)水平。结果在首次冠脉内给药后,试验组患者的TIMI皿级患者占比高于对照组(P<0.05),两组在3次冠脉内给药后TIMI II级患者占比,差异无统计学意义(P>0.05);在首次冠脉内给药后、3次给药后,试验组患者的冠脉血流CTFC帧数和对照组比较,差异无统计学意义(P>0.05);治疗前,两组患者的血清MMP-9、MPO、hs-CRP、ET-1、PECAM-1、NO、NT-proBNP、cTnI水平和对照组比较,差异无统计学意义(P>0.05);治疗后,试验组患者MMP-9、MPO、hs-CRP、ET-1、PECAM-1、NT-proBNP、cTnI水平均低于对照组(P<0.05),NO水平高于对照组(P<0.05)。结论冠脉内注射肾上腺素治疗对AMI PCI术后冠脉慢血流患者冠脉灌注水平及内皮功能损伤具有显著改善作用。

Objective To investigate the effects of intracoronary injection of epinephrine on myocardial reperfusion and vascular endothelial function in patients with acute myocardial infarction(AMI)undergoing percutaneous coronary intervention(PCI).Methods 98 patients with AMI who had slow blood flow after PCI surgery were randomLy divided into the experimental group and the control group.The experimental group received intracoronary injection of epineph-rine and the control group received intracoronary administration.Verapamil;comparison of coronary blood flow(TIMI)grading,corrected TIMI flow frame(CTFC),serum matrix metalloproteinase-9(MMP-9),and myeloperoxidation before and after treatment Enzyme(MPO),high-sensitivity C-reactive protein(hs-CRP),plasma endothelin-1(ET-1),platelet endothelial cell adhesion molecule(PECAM-1),nitric oxide(NO),amino terminal brain natriuretic peptide Precursor(NT-proBNP),troponin T(cTnl).Results After the first intracoronary administration,the TIMI level 3 patients in the experimental group accounted for a higher proportion than the control group(P<0.05),and the difference between the TIMI level 3 patients in the experimental group and the control group after 3 intracoronary administrations.There was no statistical significance(P>0.05).After the first intracoronary administration and after 3 doses,the number of coronary blood flow CTFC frames in the experimental group was not significantly different from the control group(P>0.05).Before treatment,the serum MMP-9,MPO,hs-CRP,ET-1,PECAM-1,NO levels in ihe experimental group were not significantly different from those in the control group(P>0.05);after treatment,the test The serum levels of MMP-9,MPO,hs-CRP,ET-1 and PECAM-1 were lower in the group than in the control group(P<0.05).The NO level in the experimental group was higher than that in the control group(P<O.O5).Before,the NT-proBNP and cTnI levels in the experimental group were not significantly different from those in the control group(P>0.05).After treatment,the NT-proBNP and cTnl levels in the experimental group were lower than those in the control group(P<0.05).Conclusion Intracoronary injection of epinephrine has a significant improvement in coronary perfusion and endothelial function injury in patients with coronary slow blood flow after AMI PCI.