硝普钠导管预防性注入在急诊经皮冠状动脉介入术中应用价值研究

The value of sodium nitroprusside catheter injection in emergency percutaneous coronary intervention

目的探讨硝普钠导管预防性注入在急诊经皮冠状动脉介入(PCI)术中的应用价值。方法选取自2016年8月至2018年8月接受PCI治疗的80例急诊ST段抬高型急性心肌梗死(AMI)患者为研究对象。根据随机数字表法将患者分为A组与B组,每组各40例。A组给予常规血管抽吸和PCI治疗;B组在A组治疗的基础上加用抽吸导管内硝普钠预防性注射治疗。PCI手术前、术后采用心肌梗死溶栓治疗(TIMI)血流分级评估闭塞血管的开通程度;PCI术后2 h进行心电图检查,观察患者ST段回落比例;PCI术前、术后5~7 d及术后1、6个月超声心动图检查患者左心室射血分数(LVEF)、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)等指标水平。观察术后6个月内患者主要不良心血管事件(MACE)的发生率。结果PCI术后,B组患者的无复流现象(NRP)发生率为7.5%(3/40),明显低于A组的25.0%(10/40),差异有统计学意义(P<0.05)。B组患者ST段回落比例为(88.69%±20.30%),明显高于A组的(62.30%±19.37%),差异有统计学意义(P<0.05)。PCI术后5~7 d和术后1个月,B组患者的LVEF高于A组,而LVESV、LVEDV低于A组,差异有统计学意义(P<0.05)。PCI术后6个月,两组患者的心功能指标比较,差异无统计学意义(P>0.05)。A组患者的MACE发生率为15.0%(6/40),B组患者的MACE发生率为7.5%(3/40),两组患者的MACE发生率比较,差异无统计学意义(P>0.05)。结论PCI术中开通血管后预防性冠脉内给予硝普钠对预防NRP有一定作用,可以明显改善患者的冠脉靶血管血流,改善左心室功能。

Objective To evaluate the application of sodium nitroprusside catheter in emergency percutaneous coronary intervention(PCI).Methods A retrospective study was performed on 80 cases of patients with acute ST-elevation myocardial infarction who were admitted and underwent PCI from August 2016 to August 2018.Patients were randomly divided into the Group A and Group B,with 40 cases in each group.Group A of patients were treated with routine vascular aspiration and PCI.On the basis of the treatment in Group A,Group B of patients were treated with sodium nitroprusside injection in the suction catheter.Thrombolysis in myocardial infarction(TIMI)was used before and after PCI to evaluate the degree of occlusion vascular opening.ECG examination was conducted 2 hours after PCI to observe the ST-segment regression ratio of patients.Left ventricular ejection fraction(LVEF),left ventricular end systolic volume(LVESV),left ventricular end diastolic volume(LVEDV)and other indicators were examined by echocardiography before PCI,5 to 7 days after surgery,and 1 to 6 months after surgery.The incidence of major adverse cardiovascular events(MACE)in the 6 months after operation was observed.Results After PCI,the incidence of no reflow phenomenon(NRP)in Group B was 7.5%(3/40),which was significantly lower than that in Group A(25.0%,10/40),and the difference was statistically significant(P<0.05).The proportion of ST-segment regression in Group B was(88.69%±20.30%),which was significantly higher than that in Group A(62.30%±19.37%),P<0.05.Between 5 and 7 days after PCI and 1 month after PCI,LVEF of patients in Group B was higher than that of Group A,while LVESV and LVEDV were lower than that of Group A(P<0.05).Six months after PCI,there was no statistically significant difference in cardiac function indicators between the two groups(P>0.05).The incidence of MACE in Group A was 15.0%(6/40),while that in Group B was 7.5%(3/40).There was no statistically significant difference in the incidence of MACE between the two groups(P>0.05).Conclusion In PCI,the prophylactic administration of sodium nitroprusside in the coronary artery can prevent NRP,improve the target blood flow of coronary artery and improve the left ventricular function.