冠状动脉内注射重组人脑利钠肽对急性心肌梗死经皮冠状动脉介入治疗患者心功能的影响  

Effects of intracoronary recombinant human brain natriuretic peptide onthe cardiac function in patients with acute myocardial infarction afterpercutaneous coronary intervention

作　　者：胡国勋 蔺鹏翔[1] 常江[1] 王凤[1] 闫旭丽[1] 李立灏 

机构地区：[1]武警山西总队医院介入科,太原030006

出　　处：《临床心血管病杂志》2013年第5期350-353,共4页Journal of Clinical Cardiology

摘　　要：目的:观察经皮冠状动脉(冠脉)介入治疗(PCI)急性心肌梗死(AMI)时冠脉内注射重组人脑利钠肽(rhBNP)的疗效及安全性。方法:将62例采取直接PCI治疗的前壁AMI患者随机分为冠脉内治疗组(21例)、静脉治疗组(21例)及对照组(20例),冠脉内治疗组在梗死相关血管(IRA)开通后立即给予冠脉内注射常规剂量rhBNP治疗,静脉治疗组于IRA开通后即刻静脉给予常规剂量rhBNP治疗,2组均持续使用rhBNP治疗72h;对照组单纯给予常规药物治疗。观察所有患者的心肌酶动态变化,并于术后1、4及12周行二维超声心动图检查。结果:冠脉内治疗组和静脉治疗组肌酸激酶、肌酸激酶同工酶峰值均明显低于对照组(均P<0.01)。术后4周,冠脉内治疗组每搏输出量、左室射血分数、左室舒张末期内径均优于对照组(均P<0.05);术后12周,冠脉内治疗组每搏输出量、左室射血分数、左室舒张末期内径均优于对照组和静脉治疗组(均P<0.05)。结论:IRA开通后立即冠脉内使用rhBNP是安全有效的,冠脉内使用rhBNP对AMI患者PCI术后的心肌保护作用及抑制AMI后左室重构作用均优于静脉使用rhBNP。Objective： To investigate the security and effect of intracoronary recombinant human brain natri uretic peptide （rhBNP） in patients with acute myocardial infarction （AMI） after percutaneous coronary interven-tion （PCI）. Method： A total of 62 patients with AMI after PCI were randomly divided into intracoronary group （n：21）, intravenous group （n=21） and control group （n=20）. lntracoronary injection followed by a 72-hour continuous rhBNP infusion was administrated in the intracoronary group and intravenous injection followed by a 72 hour continuous rhBNP infusion was administrated in the intravenous group after primary PCI. In the control group, patients received a routine treatment. The security of intracoronary injection of rhBNP and the dynamic changes of myocardial enzyme in all patients were observed. All the patients recieved two dimensional echocardio- graphy examination at 1st, 4th and 12th week post infarction. Result：The peak values of CK and CK MB in intra-coronary group and intravenous group were significantly lower than those in control group （P〈0.01）. Four weeks after PCI, the stroke volume, LVEF and LVEDI） in intracoronary group had significant differences com- pared with intravenous group and the control group （P〈0.05）. Conelusion：Intracoronary injection of rhBNP after PCI is safe and effective, and it can offer myocardial protection and inhibit the remodeling of left ventricular in patients with AMI after PCI.

关 键 词：急性心肌梗死 重组人脑利钠肽 冠状动脉内注射 经皮冠状动脉介入术 

分 类 号：R542.2[医药卫生—心血管疾病]