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急性心肌梗死合并急性心力衰竭患者再灌注后2小时应用西地兰对心脏胶原代谢的影响

Prognostic impact of cedilanid administration after early reperfusion 2h on collagen metabolism in acute myocardial infarction complicated with acute heart failure patients
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摘要 目的观察急性心肌梗死(AMI)合并急性心力衰竭(AHF)患者发病24h内接受经皮冠状动脉介入治疗(PCI)2h应用西地兰治疗后心功能及胶原代谢的变化。方法选择2017年1月至2018年1月期间在广州市花都区人民医院接受PCI治疗的AMI合并AHF患者93例,随机分为观察组(n=48例)和对照组(n=45例)。对照组患者于再灌注治疗后予以0.9%20mL的氯化钠注射液匀速注射,观察组患者于再灌注治疗予以0.2mg洋地黄+0.9%20mL氯化钠注射液匀速注射。比较两组患者用药前后血流动力学指标[肺毛细管楔压(PCWP)、心脏指数(CI)、每搏输出量(SV)]、实验室生化指标[肌酸激酶同工酶(CK-MB)、肌红蛋白(Myo)、肌钙蛋白(cTnI)、B型脑钠肽(BNP)]、心功能[左室射血分数(LVEF)、短轴缩短率(FS)]和胶原代谢指标[Ⅰ型C端胶原前肽(PⅠCP)及Ⅲ型N端胶原前肽(PⅢNP)]的差异。结果①血流动力学指标变化:两组患者再通后,CI、SV呈升高趋势,PCWP呈下降趋势,不同时间点两组比较差异均有统计学意义(P<0.05);②超声心动图指标变化:两组患者再通后,LVEF和FS呈升高趋势,不同时间点两组比较差异均有统计学意义(P<0.05)。用药后3h和24h,观察组患者LVEF值分别为(50.48±4.79)%和(54.08±5.12)%,FS值分别为(26.85±4.08)%和(28.45±3.97)%,均高于对照组患者(P<0.05);③血液生化指标变化:用药24h后,两组患者血CK-MB、Myo、cTnI及BNP水平均较用药前有所降低(P<0.05),同时观察组患者Myo水平和BNP含量分别为(982.46±458.51)ng/mL和(460.61±154.95)ng/mL,均高于对照组患者(769.59±346.38)ng/mL和(381.57±118.34)ng/mL(P<0.05);④胶原代谢指标变化:用药24h后,两组患者PⅠCP水平均较用药前有所升高(P<0.05),同时观察组患者PⅠCP和PⅢNP含量分别为(24.57±7.34)ng/mL和(2.68±1.51)ng/mL,明显低于对照组患者(32.64±8.29)ng/mL和(7.26±1.59)ng/mL(P<0.05)。结论AMI合并AHF患者行早期再灌注后,在常规治疗的基础上早期静脉推 Objective To observe the clinical efficacy and safety of cedilanid administration after early percutaneous coronary intervention(PCI)2 h on left ventricular remodeling and collagen metabolism in acute myocardial infarction complicated with acute heart failure(AMI-AHF)patients.Methods A total of 93 AMI-AHF patients in our hospital from January 2017 to January 2018 were selected and randomly divided into observation group(Cedilanid 0.2 mg + 0.9% saline 20 mL,n=48)and control group(0.9% saline 20 mL,n=45).The hemodynamic parameters,such as pulmonary capillary wedge pressure(PCWP),cardiac index(CI)and stroke volume(SV)were monitored.The left ventricular ejection fraction(LVEF)and short axial shortening rate(FS)were measured by doppler echocardiography.The levels of plasma creatine kinase isoenzyme(CK-MB),myoglobin(Myo),cardiac troponin I(cTnI),B type natriuretic peptide(BNP),carboxy-terminal propeptide of type Ⅰ collagen(PⅠCP)and aminoterminal propeptide of type Ⅲ collagen(PⅢNP)were detected by kits.Results ①Changes of hemodynamic indicators:the indicators of CI,SV increased,PCWP declined after reperfusion,which were significantly obvious between the groups at different time(P<O.05).(2)Changes of echocardiography indexes:the indicators of LVEF and FS increased after PCI.LVEF [(50.48 ±4.79)% and(954.08 ±5.12)%] and FS [(26.85 ±4.08)% and(28.45 ± 3.97)%] of observation group were obviously higher than control group at different times after medication of 3 h and 24 h(P<0.05).③Changes of plasma level:the levels of CK-MB,Myo,cTnI and BNP in both observation and control groups were lower than before administration at medication of 3 h and 24 h(P<0.05).And the levels of Myo[(982.46 ± 458.51)ng/mL] and BNP [(460.61 ± 154.95)ng/mL] in observation group were a little higher than control group(P<0.05).④Changes of collagen metabolism indexes:the levels of PⅠCP in both observation and control groups were higher than before administration at medication of 24 h(P<0.05).And the levels of PⅠ CP [(24.57 ± 7.34
作者 黄干洪 刘东华 肖俊会 徐志奇 李俐 Huang Gan-hong;Liu Dong-hua;Xiao Jun-hui;Xu Zhi-qi;Li Li(Department Emergency Medicine,Guangzhou Huadu People′s Hospital,Guangzhou 510800,China)
出处 《中国急救医学》 CAS CSCD 北大核心 2019年第3期226-232,共7页 Chinese Journal of Critical Care Medicine
关键词 急性心肌梗死(AMI) 急性心力衰竭(AHF) 小剂量 西地兰 早期 再灌注 胶原代谢 Acute myocardial infarction(AMI) Acute heart failure(AHF) Low dose cedilanid Early reperfusion Collagen metabolism
作者简介 黄干洪(1966-),男,副主任医师,E-mail:jdqs5474@126.com。
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