重组人脑利钠肽对老年急性前壁ST段抬高心肌梗死患者急诊介入术后心功能的影响  

Effect of rhBNP on cardiac function in elderly anterior wall ST-segment elevation acute myocardial infarction patients following PCI

作　　者：葛广豪[1,2] 杨栓锁[1,2] 马江伟[1,2] 熊三军[1,2] 窦红杰 侯月梅[1,2] 乔增勇[1,2] 方唯一[4] 

机构地区：[1]上海交通大学附属第六人民医院南院 [2]上海市奉贤区中心医院心内科,201499 [3]上海市奉贤区中心医院ICU,201499 [4]上海交通大学附属胸科医院心内科

出　　处：《中华老年心脑血管病杂志》2014年第12期1296-1300,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨重组人脑利钠肽对老年急性前壁ST段抬高心肌梗死患者急诊PCI术后心功能的影响及机制。方法选择老年急性前壁ST段抬高心肌梗死急诊PCI术后患者40例,随机分为实验组20例,在常规治疗的基础上,应用重组人脑利钠肽1.5μg/kg负荷剂量静推,再以0.0075μg/(kg·min)持续泵入72h;对照组20例,常规治疗。入选患者急诊PCI术后连续3d床头拍胸部X线,监测肌钙蛋白和中心静脉压等,于1、2、4周后行心脏彩色超声、胸部X线等检查,观察2组患者心力衰竭发生、中心静脉压和肺血管毛细血管压情况。结果实验组较对照组急性左心衰竭的发生率明显降低(20.0%vs 50.0%,P=0.025);术后24、48和72h中心静脉压和肺静脉直径明显降低;术后1周、2周LVEF明显升高[(50.12±11.20)%vs(46.34±11.49)%;(47.53±12.32)%vs(45.98±12.23)%,P<0.05],血浆肾素、血管紧张素Ⅱ和醛固酮水平明显减低(P<0.05)。结论重组人脑利钠肽可有效改善老年急性前壁心肌梗死直接PCI术后患者的心功能,效果优于单纯PCI。Objective To study the effect of rhBNP on cardiac function in elderly anterior wall STEMI patients following emergency PCI.Methods Forty anterior wall STEMI patients following PCI were randomly divided into treatment group and control group （20 in each group）.Patients in treatment group were treated with intravenous rhBNP （1.5 μg/kg） followed by continuous infusion （0.0075 μg/kg · min） for 72 h while those in control group received conventional treatment.The patients underwent chest radiography for 3 days after mergency PCI and operation.Their serum troponin level and central venous pressure were measured.The patients underwent cardiac color ultrasonography,chest radiography 1,2 and 4 weeks later.The incidence of heart failure was recorded,and their central venous pressure and pulmonary capillary wedge pressure were measured.Results The incidence of acute left heart failure was significantly lower in treatment group than in control group （20.0％ vs 50.0％,P=0.025）.The central venous pressure and pulmonary capillary wedge pressure were significantly lower 24,48 and 72 h after operation than before operation （P＜0.05）.The LVEF was significantly higher while the serum renin,angiotensin and aldosterone levels were significantly lower 1 and 2 weeks after operation than before operation （50.12％±11.20％ vs 46.34％±11.49％,47.53％±12.32％ vs 45.98％± 12.23％,P＜0.05）.Conclusion rhBNP can effectively improve the cardiac function in elderly anterior wall STEMI patients following PCI.Its effect is better than that of PCI.

关 键 词：心肌梗死 利钠肽 脑 肌钙蛋白 血管紧张素Ⅱ 醛固酮 肾素 

分 类 号：R542.2[医药卫生—心血管疾病]