曲美他嗪在急性心肌梗死患者急诊冠脉介入治疗中的应用价值  

The effect of Trimetazidine in patients with acute myocardial infarction after emergency PCI

作　　者：高晖[1] 谢芳元[1] 张清[1] 郭旭昌[1] 

机构地区：[1]西安市第四医院心内科,西安710004

出　　处：《陕西医学杂志》2013年第5期563-565,627,共4页Shaanxi Medical Journal

基　　金：陕西省自然科学基础研究计划项目(No2011JM4043)

摘　　要：目的:本研究通过观察曲美他嗪(TMZ)对急性患者急诊PCI术中血流,术后肌钙蛋白I(cTnI)、高敏C-反应蛋白(hs-CRP)、左室射血分数(LVEF)的影响,探讨TMZ对急性心梗患者急诊冠脉介入治疗的影响及可能的作用机制。方法:选择急诊行PCI治疗的急性心梗患者150例,随机分为TMZ组及对照组。TMZ组除接受常规治疗外,于术前2h给予负荷量TMZ60mg顿服,以后20mg每天3次,共治疗3月;对照组接受常规治疗。两组均采用相同的基础治疗,如抗栓、β-受体阻滞剂、血管紧张素转换酶抑制剂、他汀类药物等。观察并记录患者PCI术中TIMI血流的情况,并分别测定PCI术后24h、48h的cTnI、48h的hs-CRP值,并分别于术前、术后3月行心脏彩超,测量左室射血分数(LVEF)。结果:①两组在PCI术后24h、48h时间点的cTnI水平较术前明显升高,且均有显著性差异(P?0.05);对照组升高幅度较TMZ组更高(P?0.05)。②PCI术后48h,两组hs-CRP水平较术前均升高(P?0.05);TMZ组升高幅度较对照组低(P?0.05)。③TMZ组患者PCI术后3月行超声心动图测量LVEF较术前升高(P?0.05),而对照组PCI术前、术后3月LVEF值无差异。④TMZ组患者PCI术中TIMI血流为Ⅲ级的比率高于对照组,但无显著性差异(P>0.05)。结论:TMZ可减少PCI术后cTnI、hs-CRP浓度升高的水平,使患者LVEF值升高,提示其可减少缺血心肌损伤及可能具有促进心肌微循环改善的作用,同时能改善左心功能。Objective：To study the effect of trimetazidine on the levels of coronary blood flow and cTnI, hs-CRP and LVEF in patients with ST-elevation acute myocardial infarction after emergency PCI. To investigate the effect of trimetazidine and its protective mechanism after PCI. Methods.. 150 patients with acute myocardia infarction who undergoing emergency PCI were enrolled . All patients were randomgly divided into trimetazidine-treated group （75 cases） and routine- treated group（75 cases） . The patients in the two goups were all received the routine treat- ment. Trimetazidine-treated group added trimetazidine （60mg loading dose were gived 2 hours before emergency PCI and 20mg three time per day lasting 3 months）. The patients in the two groups were all received the same basically treatment such as B-blocker,ACEI and statins. The TIMI flow of coronary blood were obersered and recorded. The level of cTnI and hs-CRP in patients after PCI were also measured in 24 and 48 hours. Results.. The level of cTnI and hs-CRP in routine- treated group were singnificantly increased compare to trimetazidine-treated group. IN trimetazi- dine-treated group, the level of LVEF in the third months after PCI were singnificantly increased compare to before PCI. While in outine-treated group it had no difference. The rate of TIMI III flow of coronary blood in trimetazidine- treated group were higher than in routine- treated group. But it had no singnificantly difference（P 〉0.05）. Conclu- sion.. The level of cTnI and hs-CRP after PCI can be decreased by trimetazidine. The level of LVEF can be increased by trimetazidine. That indicates the ischemic myocardium injury can be decreased by trimetazidine. And microcircu- lation and LVEF can be improved by trimetazidine.

关 键 词：心肌梗塞 治疗 曲美他嗪 治疗应用 急性病 @经皮冠状动脉介入治疗术 

分 类 号：R542.22[医药卫生—心血管疾病]