冠脉内弹丸式注射水化肝素钠对急性心肌梗死PCI术中无复流患者复流情况及心肌微循环、氧化应激指标的影响

Effects of intracoronary bolus injection of hydrated heparin sodium on reflow,myocardial microcirculation and oxidative stress indexes in patients with acute myocardial infarction without reflow during PCI

目的探讨冠脉内弹丸式注射水化肝素钠对急性心肌梗死(AMI)经皮冠状动脉介入术(PCI)术中无复流患者复流情况及心肌微循环、氧化应激指标的影响。方法选择2019年2月至2021年2月收治的100例AMI PCI术中无复流患者为研究对象,采用随机数字表法将其分为对照组(50例,静脉滴注硝普钠)和观察组(50例,冠脉内弹丸式注射水化肝素钠)。比较两组的冠脉TIMI血流分级、冠脉血流指标、氧化应激指标及住院期间的不良心血管事件发生情况。结果治疗前,两组的冠脉TIMI血流各级患者占比比较,差异无统计学意义(P>0.05);治疗后,观察组的冠脉TIMI血流3级患者占比高于对照组(P<0.05)。治疗前,两组的SPV、DPV、CFVR比较,差异无统计学意义(P>0.05);治疗后,观察组的SPV、DPV、CFVR均高于对照组(P<0.05)。治疗前,两组的MDA、GSH-Px、SOD水平比较,差异无统计学意义(P>0.05);治疗后,观察组的MDA水平低于对照组,GSH-Px、SOD水平高于对照组,差异具有统计学意义(P<0.05)。观察组住院期间的不良心血管事件总发生率明显低于对照组,差异具有统计学意义(P<0.05)。结论冠脉内弹丸式注射水化肝素钠可促进AMI PCI术中无复流患者复流,并改善心肌微循环,调节氧化应激指标水平,值得临床推广。

Objective To investigate the effects of intracoronary bolus injection of hydrated heparin sodium on reflow,myocardial microcirculation and oxidative stress indexes in patients with acute myocardial infarction(AMI)without reflow during percutaneous coronary intervention(PCI).Methods A total of 100 patients with AMI without reflow during PCI admitted from February 2019 to February 2021 were selected as the research objects,and the patients were divided into control group(50 cases,intravenous infusion of sodium nitroprusside)and observation group(50 cases,intracoronary bolus injection of hydrated heparin sodium)by random number table method.The coronary TIMI flow classification,coronary blood flow indexes,oxidative stress indexes and adverse cardiovascular events during hospitalization were compared between the two groups.Results Before treatment,there was no significant difference in proportion of patients at all classification of coronary TIMI blood flow between the two groups(P>0.05);after treatment,the proportion of patients with coronary TIMI blood flow grade 3 in the observation group was higher than that in the control group(P<0.05).Before treatment,there were no significant differences in SPV,DPV and CFVR between the two groups(P>0.05);after treatment,the SPV,DPV and CFVR in the observation group were higher than those in the control group(P<0.05).Before treatment,there were no significant differences in the levels of MDA,GSH-Px and SOD between the two groups(P>0.05);after treatment,the level of MDA in the observation group was lower than that in the control group,while the levels of GSH-Px and SOD were higher than those in the control group,and the differences were statistically significant(P<0.05).The total incidence of adverse cardiovascular events during hospitalization in the observation group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Intracoronary bolus injection of hydrated heparin sodium can promote reflow in patients with AMI without reflow during PCI,improve myocardial microcirculation,and regulate the level of oxidative stress indexes,which is worthy of clinical promotion.