预防性冠状动脉注射硝酸甘油和地尔硫对急性心肌梗死心肌微灌注影响的临床研究被引量：2

Prophylactic Intra-Coronary Injection Nitroglycerin With Diltiazem in Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction

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摘要目的:在急诊介入治疗中,评价预防性冠状动脉(冠脉)内联合注射硝酸甘油和地尔硫(艹卓)对于改善急性 ST 段抬高型心肌梗死(STEMI)心肌微灌注的有效性和安全性。方法:根据是否预防性冠脉注射硝酸甘油和地尔硫(艹卓)将2001年1月至2006年12月在我中心接受急诊冠脉介入治疗的212例 STEMI 患者分为两组,预防性使用上述药物者为研究组(87例),而进行常规介入治疗者为埘照组(125例)。比较两组间基础资料、造影参数、ST 段回落幅度,术后5日心肌生化标记物曲线下面积、左心室射血分数、左心室舒张末内径和随访期间(平均随访17个月)主要心血管病事件的差异。结果:研究组住院及随访期间共计有10例(11.5%)发生主要心血管病事件,对照组为28例(22.4%),两组差异显著(P=0.042);两组因心脏原因再次住院次数差异显著(研究组19.5% vs 对照组37.6%,P=0.008)。研究组的无血流或慢血流发生较对照组少,但未显示出统计学差异,研究组较对照组校正的心肌梗死溶栓治疗临床试验帧数计数(cT-FC)值较低(34.4±11.3 vs 38.9±17.2,P=0.034),心肌微灌注分级(MBG)较高(2.65±0.6 vs 2.41±0.7,P=0.018),提示研究组心肌微灌注优于对照组。研究组较对照组 ST 段回落幅度显著,术后5日心肌生化标记物肌酸激酶同工酶(CK-MB)曲线下面积较小(P<0.05);术后心脏超声左心室射血分数高及舒张末内径较小,均显著优于对照组(P<0.05)。结论:预防性冠脉联合注射硝酸甘油和地尔硫草可改善急性 ST 段抬高型心肌梗死心肌组织微灌注、减少心肌坏死生化标记物的释放、减少近期死亡等主要心血管病事件的发生,改善中、远期临床预后。 Objective：To evaluate the influence of prophylactic intracoronary injection nitroglycerin with diltiazem in patients of acute ST segment elevation myocardial infarction（STEMI） Methods ：This study was conducted in 212 patients with acute STEMI who underwent primary percutaneous coronary intervention （PCI） in our center from January 2001 to December 2006. The patients were randomly assigned to receive intra-coronary nitroglycerin with diltiazem（n = 87 ） or none of them（ 125 ） before intervention. The clinical data,coronary angiography data after intervention ,ST-segment resolution ,area under the curve of CK-MB ,ejection fraction（EF） and left ventricular end-diastolic di- mension several days after operation and the major adverse cardiac events（MACE） were analyzed systemically. Results ： Ten （ 11.5 % ） patients in study group and 28 （ 22.4% ） in control group had MACE （ P = 0. 042 ）. The difference of re-hospitalization was also significant （19. 5% vs 37.6% ,P = 0. 008 ）. No/slow re/low occurred less in study group than in contml group,but the difference was not significant. Corrected TIMI frame count was lower（34. 4 ± 11.3 vs 38.9 ± 17. 2 ,P =0. 034）and myocardial blush grade was higher（ 2. 65 ±0. 6 vs 2.41 ± 0. 7, P = 0. 018 ）in study group. ST-segment resolution , area under the curve of CK-MB in 5 days after operation, EF and left ventricular end-diastolic dimension in study group were more significant than those in control group （P 〈 0. 05 ）. Conclusions：Prophylactic intra-coronary injection nitroglycerin with diltiazem in primary PCI can improve myocardial microperfusion and reduce myocardial necrosis. It may improve mid- and long-term clinical outcomes and prevent cardiovascular events in patients with STEMI.

作者王禹张国明苏绍萍孙志军陈练沈洪王峙峰金琴花杨庭树盖鲁粤计达陈威宋杨张志强韩辉王芯芯钱远宇武建军黄先勇

机构地区中国人民解放军总医院心血管内科中国人民解放军总医院急诊科

出处《中国循环杂志》 CSCD 北大核心 2007年第6期411-414,共4页 Chinese Circulation Journal

关键词急性ST段抬高型心肌梗塞心肌微灌注硝酸甘油地尔硫[艹卓] Acute myocardial infarction Myocardial perfusion Nitroglycerin Dihiazem

分类号 R541.4 [医药卫生—心血管疾病]

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