左西孟旦治疗急性冠脉综合征行PCI后血管无复流并发心力衰竭的临床疗效及其对心功能的影响

Clinical efficacy of levosimendan in the treatment of no reflow of diseased vessels complicated with heart failure after PCI in acute coronary syndrome and its influence on cardiac function

目的 观察左西孟旦治疗急性冠脉综合征(ACS)行经皮冠状动脉介入术(PCI)后病变血管无复流并发心力衰竭效果及对心功能的影响。方法 选取2019年1月—2021年6月礼县第一人民医院收治的ACS行PCI后无复流并发心力衰竭患者107例,按照随机数字表法分为A组(n=53)和B组(n=54)。A组患者予以注射用硝普钠+盐酸替罗非班注射用浓溶液,B组患者在A组治疗基础上增加左西孟旦注射液。2组均治疗7 d。比较2组心肌灌注情况,治疗前、治疗7 d后心功能指标[左心室射血分数(LVEF)、心排血指数(CI)]、心肌损伤指标[心肌肌钙蛋白I(cTnI)、B型钠尿肽(BNP)、肌酸激酶同工酶(CK-MB)、丙氨酸氨基转移酶(ALT)]、炎性反应指标[白细胞计数(WBC)、超敏C反应蛋白(hs-CRP)],主要不良心血管事件(MACE)、不良反应发生率。结果 治疗7 d后,B组心肌灌注分级优于A组(u=2.109,P=0.035);2组LVEF、CI高于治疗前,且B组高于A组(P<0.05或P<0.01);2组cTnI、BNP、CK-MB、ALT低于治疗前,且B组低于A组(P<0.01);2组WBC、hs-CRP低于治疗前,且B组低于A组(P<0.01)。2组MACE发生率、不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 左西孟旦治疗ACS行PCI后血管无复流并发心力衰竭能明显改善患者的心肌灌注,可降低炎性反应,减轻心肌损伤,改善心功能,且不会增加MACE、不良反应。

Objective To observe the clinical efficacy of levosimendan in the treatment of no reflow of diseased vessels complicated with heart failure after percutaneous coronary intervention(PCI)in acute coronary syndrome(ACS)and its influence on cardiac function.Methods A total of 107 cases of patients with no reflow of diseased vessels complicated with heart failure after PCI in ACS patients were selected from January 2019 to June 2021 in Lixian First People′s Hospital,which were divided into group A(n=53)and group B(n=54)according to the random number table method.Group A was treated with sodium nitroprusside for injection+tirofiban hydrochloride concentrated solution for injection.Group B was treated with levosimendan injection on the basis of group A.Both groups were treated for 7 days.The myocardial perfusion,cardiac function indexes(LVEF,CI),myocardial injury indexes(cTnI,BNP,CK-MB,ALT)before and after 7 days of treatment,incidence of MACE and adverse reactions were compared between the two groups.Results After 7 days of treatment,the myocardial perfusion grade of group B was better than that of group A(u=2.109,P=0.035).After 7 days of treatment,LVEF and CI of the two groups were higher than those before treatment,and those in group B were higher than group A(P<0.05 or P<0.01).After 7 days of treatment,cTnI,BNP,CK-MB,ALT of the two groups were lower than those before treatment,and those in group B were lower than group A(P<0.01).After 7 days of treatment,WBC and hs-CRP in the two groups were lower than those before treatment,and those in group B were lower than group A(P<0.01).There was no significant difference in the incidence of MACE and the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Levosimendan can significantly improve myocardial perfusion in ACS patients with no reflow of diseased vessels complicated with heart failure after PCI,it can reduce the level of inflammation,reduce myocardial damage,improve cardiac function,and will not increase MACE and adverse reactions.