磷酸肌酸钠对经皮冠状动脉介入术中慢/无复流急性ST段抬高型心肌梗死患者心肌及左心室功能影响研究

The influence of creatine phosphate sodium on myocardial protection and left ventricular function in acute ST-segment elevation myocardial infarction patients with slow/no-reflow during percutaneous coronary intervention

目的探讨磷酸肌酸钠对经皮冠状动脉介入术(PCI)中慢/无复流的急性ST段抬高型心肌梗死(STEMI)患者心肌及左心室功能的影响。方法选取自2017年8月至2019年12月邢台市第三医院(邢台市心血管病医院)收治的STEMI患者128例,按照随机数字表法将患者分为常规组(n=64)与观察组(n=64例)。两组患者均于发病后12 h内行PCI治疗,常规组患者给予常规药物治疗,观察组在常规组药物治疗基础上给予磷酸肌酸钠治疗。治疗14 d后,评估两组患者的临床疗效。记录并比较两组患者治疗前、治疗14 d后的心率变异性[正常R-R间期标准差(SDNN)、相邻正常R-R间期差值>50 ms心搏数占分析心搏数总数的百分比(PNN50)、连续5 min正常R-R间期平均值标准差(SDANN)、相邻NN间期差值的均方根(RMSSD)]、血清心肌损伤指标[血清肌酸激酶同工酶(CK-MB)、血清脑钠肽(BNP)、心肌肌钙蛋白Ⅰ(cTnⅠ)]、左心室功能[左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)]。PCI术后随访6个月,记录并比较两组患者主要不良心血管事件(心力衰竭、再发性心肌梗死、恶性心律失常、心脏骤停、心源性休克等)发生情况。结果观察组治疗总有效率为92.2%(59/64),高于常规组的79.7%(51/64),差异有统计学意义(P<0.05)。治疗后,两组患者SDNN、PNN50、SDANN、RMSSD、LVEF均高于治疗前,且观察组高于常规组;两组患者LVESV、LVEDV均低于治疗前,且观察组低于常规组,差异均有统计学意义(P<0.05)。治疗后,两组患者血清CK-MB、cTnⅠ、BNP水平均较治疗前降低,且观察组低于常规组,差异均有统计学意义(P<0.05)。观察组患者主要不良心血管事件总发生率为7.8%(5/64),显著低于常规组的20.3%(13/64),差异有统计学意义(P<0.05)。结论磷酸肌酸钠可减轻PCI术中慢/无复流的STEMI患者的心肌损伤,改善心率变异性以及左心室功能,降低主要不良心血管事件发生风险。

Objective To investigate the influence of creatine phosphate sodium on myocardial protection and left ventricular function in acute ST-segment elevation myocardial infarction(STEMI)patients with slow/no-reflow during percutaneous coronary intervention(PCI).Methods A retrospective study was performed on 128 patients with STEMI in Xingtai Third Hospital(Xingtai Cardiovascular Hospital)from August 2017 to December 2019.The STEMI patients were randomly divided into conventional group(n=64)and observation group(n=64).The patients in the two groups were treated with PCI within 12 hours after onset.Furthermore,the conventional group received conventional medical treatment,while the observation group received creatine phosphate sodium on the basis of conventional treatment.The clinical efficacy of the two groups was evaluated when they were treated for 14 days.Before the treatment and after treating for 14 days,the heart rate variability[standard deviation of the normal R-R interval(SDNN),percentage of differences exceeding 50 ms between the adjacent normal R-R intervals(PNN50),standard deviation of the average value of normal R-R intervals for 5 min(SDANN),square root of the mean squared differences of successive NN intervals(RMSSD)],serum myocardial injury indexes[creatine kinase isoenzyme(CK-MB),brain natriuretic peptide(BNP),cardiac troponinⅠ(cTnⅠ)],left ventricular function[left ventricular ejection fraction(LVEF),left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV)]were recorded and compared between the two groups.The patients were followed up for 6 months,and the major adverse cardiovascular events(heart failure,recurrent myocardial infarction,malignant arrhythmia,cardiac arrest,cardiogenic shock)were recorded and compared between the two groups.Results The total effective rate of the observation group was 92.2%(59/64),significantly higher than that of the conventional group[79.7%(51/64)].After treatment,SDNN,SDANN,RMSSD,pNN50 and LVEF of the two groups were significantly increased,and those of the observation group were significantly higher than those of the conventional group(P<0.05).After treatment,LVESV、LVEDV of the two groups were significantly decreased,and those of the observation group were significantly lower than those of the conventional group(P<0.05).After treatment,CK-MB,cTnⅠ,BNP of the two groups were significantly decreased,and those of the observation group were significantly lower than those of the conventional group(P<0.05).Follow-up for 6 month,the incidence of major adverse cardiovascular events in the observation group[7.81%(5/64)]was significantly lower than that in the control group[20.31%(13/64),P<0.05].Conclusion Creatine phosphate sodium can reduce myocardial damage in STEMI patients with slow/no-reflow during PCI,improve heart rate variability and left ventricular function,reduce the risk of major adverse cardiovascular events.