硝酸甘油联合参附注射液治疗急性ST段抬高型心肌梗死的临床效果

Clinical effect of nitroglycerin combined with Shenfu injection in the treatment of acute ST segment elevation myocardial infarction

目的探讨硝酸甘油联合参附注射液治疗急性ST段抬高型心肌梗死(STEMI)的临床效果。方法选取2021年1月—2022年6月石家庄市栾城区人民医院收治的60例急性STEMI患者作为研究对象,按照随机数字表法将其分为对照组(30例)和观察组(30例)。对照组于院前急救中采用硝酸甘油注射液静脉滴注治疗,观察组于院前急救中采用硝酸甘油联合参附注射液静脉滴注治疗,入院后两组均采用常规方案进行长期治疗。比较两组患者临床治疗效果,治疗前后的心率、血压、血氧饱和度等生命体征指标及疼痛评分,不同时间的心肌肌钙蛋白I(cTnI)水平,治疗后心功能指标。结果观察组患者临床治疗效果优于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者心率、收缩压、舒张压、血氧饱和度、疼痛评分比较差异无统计学意义(P>0.05);治疗后,两组患者心率较治疗前减慢,收缩压、舒张压和血氧饱和度较治疗前升高,疼痛评分较治疗前降低,且观察组心率慢于对照组,收缩压、舒张压和血氧饱和度高于对照组,疼痛评分低于对照组,差异有统计学意义(P<0.05)。整体分析发现:cTnI水平组间比较、时间点比较、交互作用比较差异有统计学意义(P<0.05)。进一步两两比较,组内比较:两组患者用药后6、12、24 h的cTnI水平均低于入院时,两组患者用药后12、24 h的cTnI水平均低于用药后6 h,两组患者用药后24 h的cTnI水平均低于用药后12 h,差异有统计学意义(P<0.05);组间比较:观察组患者入院时、用药后6 h、用药后12 h、用药后24 h的cTnI水平均低于对照组,差异有统计学意义(P<0.05)。治疗后3个月,观察组患者左室射血分数、E峰、E/A均高于对照组,差异有统计学意义(P<0.05);两组患者A峰比较差异无统计学意义(P>0.05)。结论硝酸甘油和硝酸甘油联用参附注射液治疗急性STEMI均能取得一定的效果,但硝酸甘油联用参附注射液效果更佳。

Objective To investigate clinical effect of nitroglycerin combined with Shenfu injection in the treatment of acute ST segment elevation myocardial infarction(STEMI).Methods Sixty patients with acute STEMI admitted to People's Hospital of Luancheng District in Shijiazhuang City from January 2021 to June 2022 were selected as the study subjects.They were divided into control group(30 cases)and observation group(30 cases)by using random number table method.The control group received intravenous drip of nitroglycerin injection during pre-hospital emergency treatment,while observation group received intravenous drip of nitroglycerin combined with Shenfu injection during prehospital emergency treatment.Both groups received long-term treatment with conventional regimen after admission.Clinical treatment effect,vital sign indicators such as heart rate,oxygen saturation of blood,blood oxygen,and pain scores before and after treatment,cardiac troponin I(cTnI)levels at different times,cardiac function indicator after treatment of two groups were compared.Results Clinical treatment effect of observation group was better than that of control group,and the difference was statistically significant(P<0.05).Before treatment,there were no statistically significant differences in heart rate,systolic oxygen saturation of blood,diastolic oxygen saturation of blood,blood oxygen and pain scores between two groups(P>0.05).After treatment,heart rates of two groups were slower than those before treatment,systolic oxygen saturation of blood,diastolic oxygen saturation of blood and blood oxygen of two groups were higher than those before treatment,pain scores of two groups were lower than those before treatment,and heart rate of observation group was slower than that of control group,systolic oxygen saturation of blood,diastolic oxygen saturation of blood and blood oxygen of observation group were higher than those of control group,and pain score of observation group was lower than that of control group,and the differences were statistically significant(P<0.05).Overall analysis found that there were statistically significant differences in cTnI levels between groups,time points,and interactions(P<0.05).Further pairwise comparison,intra group comparison:cTnI levels at six,12,and 24 hours after medication in both groups were lower than those at the time of admission,cTnI levels at 12 and 24 hours after medication in both groups were lower than those at six hours after medication,cTnI levels at 24 hours after medication in both groups were lower than those at 12 hours after medication,and the differences were statistically significant(P<0.05).group comparison:cTnI levels in observation group were lower than those in control group at the time of admission,six hours after medication,12 hours after medication,and 24 hours after medication,and the differences were statistically significant(P<0.05).Three months after treatment,left ventricular ejection fraction,E-peak and E/A in observation group were higher than those in control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference between two groups of A-peak(P>0.05).Conclusion Both nitroglycerin and nitroglycerin combined with Shenfu injection can achieve a certain therapeutic effect in the treatment of acute STEMI,but nitroglycerin combined with Shenfu injection has a better effect.