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目的:探讨乌司他丁(UTI)预处理对急诊冠状动脉介入治疗(PCI)患者心肌缺血再灌注损伤的影响。方法:将120例急性心肌梗死(AMI)患者随机分成两组:试验组(n=62)采用UTI预处理+常规PCI治疗,对照组(n=58)采用常规PCI治疗,比较两组患者PCI术前和术后2 h、12 h、24 h、72 h的肌钙蛋白I(cTnI)、超敏C反应蛋白(hs-CRP)水平、再灌注心律失常的发生率和术后7天SPECT静息心肌灌注显像、治疗后3个月心功能情况和主要不良心血管事件(MACE)发生率。结果:两组术前cTnI、hs-CRP水平无明显差异(P>0.05),试验组术后各时点cTnI、hs-CRP水平明显低于对照组(P<0.05);试验组再灌注心律失常的发生率明显少于对照组(P<0.05);SPECT半定量分析显示术后第7天心肌缺血面积、心肌坏死面积试验组均明显小于对照组(P<0.05,P<0.01);随访3个月,试验组患者心功能明显改善,且MACE发生率低于对照组(P<0.05)。结论:UTI可显著减轻急诊PCI患者心肌缺血再灌注损伤,减轻炎症反应,减少心肌坏死,保护心功能,改善患者预后。
Objective: To investigate the effect of UTI on myocardial ischemia-reperfusion injury in patients undergoing emergency PCI. Methods: One hundred and twenty patients with acute myocardial infarction (AMI) were randomly divided into two groups: the experimental group (n = 62) was treated with UTI pretreatment and conventional PCI, the control group (n = 58) The levels of cTnI, hs-CRP and the incidence of reperfusion arrhythmia at 2 h, 12 h, 24 h and 72 h after surgery and before surgery were compared with those at 7 days after surgery Resting myocardial perfusion imaging, cardiac function at 3 months after treatment, and incidence of major adverse cardiovascular events (MACE). Results: The levels of cTnI and hs-CRP were not significantly different between the two groups (P> 0.05). The levels of cTnI and hs-CRP in the experimental group were significantly lower than those in the control group (P <0.05) (P <0.05). The SPECT semiquantitative analysis showed that myocardial ischemic area and myocardial necrosis area in the experimental group on the 7th day after operation were significantly lower than those in the control group (P <0.05, P <0.01). The follow-up of 3 months, the test group patients with cardiac function improved significantly, and the incidence of MACE was lower than the control group (P <0.05). Conclusion: UTI can significantly reduce myocardial ischemia-reperfusion injury, reduce inflammation, reduce myocardial necrosis, protect cardiac function and improve prognosis in emergency PCI patients.