重组人脑利钠肽治疗急性STEMI再灌注后早期心律失常的疗效观察

Observation on efficacy of recombinant human brain natriuretic peptide on early arrhythmia after reperfusion treatment of acute STEMI

目的探究重组人脑利钠肽治疗急性ST段抬高型心肌梗死(STEMI)再灌注后早期心律失常的临床疗效。方法86例接受溶栓治疗的急性STEMI患者为研究对象,随机分为对照组与观察组,各43例。两组均接受溶栓治疗,观察组在常规药物治疗基础上予以重组人脑利钠肽治疗。比较两组术后24 h内心律失常发生情况,术前、术后72 h心肌酶谱[肌酸激酶同工酶(CK-MB)、肌钙蛋白T(cTnT)],术前、术后3个月心功能指标[左心室舒张末期内径(LVEDd)、左室射血分数(LVEF)],术后3个月心脏不良事件发生情况。结果术后24 h内,观察组窦性心动过缓、室性心动过速、窦性停搏、心室颤动发生率分别为6.98%、13.95%、2.33%、0,均低于对照组的44.19%、51.16%、16.28%、9.30%,差异有统计学意义(P<0.05)。术后72 h,观察组CK-MB、cTnT水平分别为(37.08±10.45)ng/ml、(6.31±1.46)μg/L,均低于对照组的(42.34±11.40)ng/ml、(7.27±1.25)μg/L,差异有统计学意义(P<0.05)。术后3个月,观察组LVEDd(44.25±3.02)mm小于对照组的(46.10±3.27)mm,LVEF(47.94±4.78)%高于对照组的(44.79±5.67)%,差异有统计学意义(P<0.05)。术后3个月,观察组心脏不良事件发生率为4.65%,低于对照组的20.93%,差异有统计学意义(P<0.05)。结论急性STEMI患者应用重组人脑利钠肽治疗,可降低其再灌注后早期心律失常发生率,减少心肌损伤,稳定心肌结构,降低心脏不良事件发生率,效果理想。

Objective To investigate the clinical efficacy of recombinant human brain natriuretic peptide on early arrhythmia after reperfusion treatment of acute ST elevation myocardial infarction(STEMI).Methods A total of 86 patients with acute STEMI who received thrombolytic therapy were selected as the research subjects,and they were randomly divided into the control group and the observation group,with 43 cases in each group.Both groups received thrombolytic therapy,while the observation group received recombinant human brain natriuretic peptide therapy on the basis of conventional drug therapy.Both groups were compared in terms of occurrence of arrhythmia 24 h after surgery,myocardial enzyme spectrum[creatine kinase isoenzyme(CK-MB),cardiac troponin T(cTnT)]before surgery and 72 h after surgery,cardiac function indicators[left ventricular enddiastolic diameter(LVEDd),left ventricular ejection fraction(LVEF)]before surgery and 3 months after surgery,and incidence of adverse cardiac events 3 months after surgery.Results Within 24 h after surgery,the incidence rates of sinus bradycardia,ventricular tachycardia,sinus arrest,and ventricular fibrillation in the observation group were 6.98%,13.95%,2.33%,and 0,which were lower than 44.19%,51.16%,16.28%,and 9.30%in the control group,and the differences were all statistically significant(P<0.05).At 72 h after surgery,the levels of CK-MB and cTnT in the observation group were(37.08±10.45)ng/ml and(6.31±1.46)μg/L,which were lower than(42.34±11.40)ng/ml and(7.27±1.25)μg/L in the control group,and the differences were all statistically significant(P<0.05).At 3 months after surgery,the LVEDd(44.25±3.02)mm of the observation group was less than(46.10±3.27)mm of the control group,and the LVEF(47.94±4.78)%was higher than(44.79±5.67)%of the control group,and the differences were all statistically significant(P<0.05).At 3 months after surgery,the incidence of cardiac adverse events in the observation group was 4.65%,which was lower than 20.93%in the control group,and the difference was statistically significant(P<0.05).Conclusion Recombinant human brain natriuretic peptide has ideal effect on patients with acute STEMI patients,which can reduce the incidence of early arrhythmia after reperfusion,reduce myocardial damage,stabilize myocardial structure,and reduce the incidence of adverse cardiac events.