美托洛尔注射液早期治疗非ST段抬高急性心肌梗死患者血清氨基端脑钠肽前体水平研究  

Clinical Investigation on Plasma Concentration of NT-ProBNP for Metoprolol Injection in Patients With Non-ST-Elevation Acute Myocardial Infarction

作　　者：刘新兵[1] 黄红漫[1] 冯六六[1] 涂春莲[2] 方旭晨[2] 俞建华[1] 周明成[1] 许其倓[1] 陈允硕[3] 

机构地区：[1]上海市杨浦区市东医院心内科,200438 [2]上海市杨浦区市东医院危重病医学科,200438 [3]上海市杨浦区市东医院检验科,200438

出　　处：《中国循环杂志》2008年第6期418-421,共4页Chinese Circulation Journal

基　　金：上海市杨浦区卫生局科研立项课题;课题编号(200805)

摘　　要：目的:观察美托洛尔注射液早期治疗非ST段抬高急性心肌梗死患者血清氨基端脑钠肽前体(NT-ProBNP)水平变化。方法:将69例非ST段抬高急性心肌梗死患者(Killip分级Ⅰ～Ⅱ级)随机分成两组,治疗组34例为症状出现24 h内予静脉注射美托洛尔,对照组35例为常规治疗。两组均在入选6 h内、第7天和第28天检测血清NT-ProBNP浓度以及监测第1天、第28天左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVEDs)、室上性和室性心律失常计数。结果:血清NT-ProBNP浓度变化:治疗组第7天、第28天血清NT-ProBNP浓度分别为(155.43±30.56)pg/ml、(105.43±30.56)pg/ml与对照组第7天、第28天(289.9±42.3)pg/ml、(209.9±42.3)pg/ml比较明显下降,差异有统计学意义(P<0.05);且治疗组第7天血清NT-ProBNP浓度与最初6 h血清NT-ProBNP浓度(320.2±50.5)pg/ml相比也明显下降,差异有统计学意义(P<0.05)。69例患者28天内死亡4例患者与非死亡65例患者平均血清NT-ProBNP水平分别为〔(620.8±160.5)pg/ml、(187.8±89.6)pg/ml〕,两者比较差异有统计学意义(P<0.05)。心脏超声变化:治疗组第1天和第28天的前后差值与对照组第1天和第28天的前后差值比较,左心室舒张末期内径、左心室收缩末期内径显著减少,差异均有统计学意义(P<0.05)。动态心电图监护:治疗组第1天和第28天的前后差值与对照组第1天和第28天的前后差值比较,室上性心律失常计数、室性心律失常计数显著升高,差异均有统计学意义(P<0.05)。结论:非ST段抬高急性心肌梗死患者早期应用美托洛尔注射液治疗是安全的,并能显著降低血清NT-ProBNP水平,降低心律失常发生,改善心室重塑。死亡患者血清NT-ProBNP浓度显著升高。Objective ：To investigate plasma concenrtration of NT-ProBNP for metoprolol injection in patients with non-ST-elevation acute myocardial infarction（AMI）. Methods ： A total of 69 patients with non-ST-elevation AMI were randomly divided into two groups. Treatment group ： n = 34, the patients were treated with metoprolol injection within 24 hours of symptoms appeared ; Control group ： n = 35, the patients were treated with routine medication. Plasma NT-ProBNP concentrations were measured in both groups at 6 hours, 7 days and 28 days respectively. Left ventricular end-diastolic dimension （ LVEDD）, Left ventricular end-systolic dimension （ LVESD ）, superventricular arrhythmia and ventricular arrhythmia were monitored at 24 hours and 28 days respectively. Results ：Plasma concentration of NT-ProBNP was significantly decreased in treatment group at 7 days and 28 days（ 155.43 ± 30. 56 pg/ml and 105.43 ±30. 56 pg/ml） than in control group（289. 9 ±42. 3 pg/ml and 209. 9 ±42. 3 pg/ml）, （P 〈0. 05）. 4 patients died, 1 in treatment group and 3 in control group. NT-ProBNP concentration in died patients（620. 8±160. 5 pg/ml）was significantly higher than in alive patients（ 187.8 ± 89.6 pg/ml）, （ P 〈0.05 ）. More changes of LVESD and LVEDD were found in treatment group （ 1.3 ± 0. 1 mm and 2. 1 ± 0. 3 mm） than in control group （4. 7± 0.4 mm and 6. 9 ±0. 8 mm）, （ P 〈 0. 05 ）. Changes of the count for super-ventricular arrhythmia or ventricular arrhythmia at the first day and 28 days were significantly increased in treatment group （ 199.0 ± 42. 2 and 509. 8 ± 95.4 ） than in control group （ 80. 9 ± 35.2 and 200. 7 ± 46. 5 ）, （ P 〈 0. 05 ）. Conclusion： Metoprolol injection was safe in patients with non-ST-elevation AMI. Plasma concentration of NT-ProBNP was significantly lower in treatment group than in control group. Super-ventricular or ventricular arrhythmia was decreased and left ventricular remodeling was improved by metroprolol inj

关 键 词：心肌梗塞 急性 美托洛尔 脑钠肽 

分 类 号：R541.4[医药卫生—心血管疾病]