曲美他嗪对急性心肌梗死直接经皮冠状动脉介入治疗的影响  

The effect of Trimetazidine to Percutaneous Coronary Intervention on the reperfusion of acute myocardial infarction.

作　　者：李勇[1] 刘峰[1] 邵波[1] 刘广安[1] 

机构地区：[1]上海交通大学医学院苏州九龙医院心内科,江苏苏州215000

出　　处：《中国实用内科杂志》2009年第S1期58-60,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的探讨在急性心肌梗死(AMI)直接经皮冠状动脉介入治疗(PCI)前应用曲美他嗪(商品名:万爽力)(TMZ)对AMI再灌注治疗的影响。方法分析行直接PCI血流达TIMI2-3级的60例初发ST段抬高型急性心肌梗死患者;除冠心病2级预防用药外,30例直接PCI前使用TMZ作为研究组,30例未使用TMZ患者作为对照组。研究组在确诊AMI后即刻服用TMZ60mg,随后20mg,3次/d。比较两组直接PCI前后的心电图ST段降幅,血心肌肌钙蛋白I(cTnI)水平及4周后超声心动图检测的左室射血分数(LVEF),左室短轴缩短率(LVFS)变化。结果研究组患者直接PCI后ST段下降幅度值显著高于对照组P<0.05;研究组的cTnI于PCI治疗后6 h显著低于对照组P<0.05,并持续到24小时P<0.01;两组4周末LVEF,LVFS均较入院24h内差异有显著性P<0.05,两组间比较差异有显著性P<0.05。结论 AMI患者在直接PCI前使用TMZ可增加ST段的降幅,减少心肌损害,对心肌细胞保护作用明显,有利于心功能恢复。Objective To discuss the effect of early using Trimetazidine(TMZ) before direct Percutaneous Coronary Intervention (PCI) on the reperfusion of acute myocardial infarction(AMI).Methods A total of 60 direct-PCI patients with ST Elevation Myocardial Infarction(STEMI) were divided into two groups.One group used TMZ before PCI was study-group,another one didn' t use TMZ was contrast-group.Both groups got based medicines for AMI.All of them gained Thrombolysis In Myocardial Infarction(TIMI)Ⅱ-Ⅲgrade perfusion flow.The patients in study-group got TMZ 60 mg at once before PCI,and then TMZ 20 mg tid.The decrease of ST elevation at ECG after PCI,the density of blood cTnI,LVEF and LVFS in UCG checked after 4 weeks were compared in two groups.ResuIts The noticeable decrease of ST elevation at ECG after PCI in study-group was showed(P<0.05).The density of blood cTnI in study-group was lower than in contrast-group at 6 hours after direct-PCI(P<0.05),and the same result was lasted to 24 hours(P<0.01). The prominent contrast in LVEF and LVFS was showed in the same group at 4 weeks compared with the first 24 hours (P<0.05).It also could be seen between two groups at 4 weeks(P<0.05).Conclusion TMZ used bofore direct PCI can decrease the amplitude of ST Elevation on ECG in patients with AMI.It decreases the damage to myocardium.It protects the myocardial-cell.It have a beneficial effcet to recovery of heart funcion.

关 键 词：曲美他嗪 心肌梗死 经皮冠状动脉介入治疗 细胞保护 心功能 

分 类 号：R542.22[医药卫生—心血管疾病]