曲美他嗪对急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗术后短期心功能的影响  

Effect of trimetazidine on short-term cardiac function in acute ST-elevation myocardial infarction patients after emergency percutaneous coronary intervention

作　　者：李远征[1] 王立中[1] 董鹏[1] 刘芳[1] 姜阳[1] 李银花[1] 

机构地区：[1]航空总医院心内科,北京100012

出　　处：《中国医药》2016年第7期954-957,共4页China Medicine

摘　　要：目的探讨曲美他嗪对急性ST段抬高型心肌梗死（STEMI）患者行急诊经皮冠状动脉介入治疗（PCI）术后短期心功能的影响。方法连续入选2013年11月至2015年11月于航空总医院心内科及首都医科大学大兴医院行急诊PCI术术后冠状动脉血流均达心肌梗死溶栓治疗血流分级3级的STEMI患者75例，按照随机数字表法分为对照组、低剂量曲美他嗪组和高剂量曲美他嗪组，每组25例。3组均于PCI术后给予常规冠状动脉粥样硬化性心脏病二级预防治疗，低剂量和高剂量曲美他嗪治疗组在此基础上分别加用曲美他嗪20mg／次和40mg／次，3次／d口服。观察比较3组患者在PCI术后1周、1个月和3个月时血浆N-末端脑钠肽前体（NT-proBNP）、左心室舒张末期内径（LVEDD）和左心室射血分数（LVEF）水平。结果PCI术后1周时，低剂量和高剂量曲美他嗪治疗组患者血浆NT-proBNP水平明显低于对照组，差异有统计学意义[（986±403）、（895±387）ng／L比（1453±428）ng／L，P〈0．05]，而低剂量和高剂量曲美他嗪组问差异无统计学意义（P〉0．05）；3组LVEDD和LVEF水平差异无统计学意义（P〉0．05）。PCI术后1个月和3个月时，3组间血浆NT-proBNP水平差异无统计学意义（P〉0．05），而低剂量和高剂量曲美他嗪组LVEDD水平明显低于、LVEF水平明显高于对照组，差异均有统计学意义[（52±4）、（51±4）mm比（58±4）mm，（52±3）、（49±4）mm比（58±4）mm，（53±5）％、（54±6）％比（46±6）％，（54±5）％、（55±5）％比（46±5）％，均P〈0．05]；高剂量曲美他嗪组LVEDD和LVEF水平与低剂量曲美他嗪组比较，差异无统计学意义（P〉0．05）。结论曲美他嗪对于改善STEMI患者急诊PCI术后短期的心脏结构和功能可能有益，但曲美他嗪的治疗剂量和时间依赖性尚需进一步观察。Objective To investigate the effect of trimetazidine on short-term cardiac function in acute ST-elevation myocardial infarction （ STEMI ） patients after emergency percutaneous coronary intervention （ PCI ）. Methods Totally 75 STEMI patients after PCI with Thrombolysis In Myocardial Infarction coronary flow grade 3 were consecutively enrolled from November 2013 to November 2015 in Aviation General Hospital and Daxing Hospital, Capital Medical University. All patients were randomly divided into control group, low dose trimetazidine group and high close trimetazidine group, each group had 25 cases. All 3 groups were given routine secondary prevention treatment of coronary heart disease after PCI, low and high close trimetazidine groups were respectively added trimetazidine 20 mg/time and 40 rag/time, 3 times/d orally. Plasma amino-terminal pro-brain natriuretic peptide（ N-proBNP ）, left ventricular end-diastolic dimension （LVEDD）and left ventricular ejection fraction （LVEF） at 1 week, 1 month and 3 months after PCI were analyzed. Results At I week after PCI, plasma levels of N-proBNP in low and high dose trimetazidine groups were significantly lower than control group [ （986± 403 ） , （ 895±387 ） ng/L vs （ 1 453± 428 ） ng/L] （ P 〈 0. 05 ） ; the difference of N-proBNP between 2 trimetazidine groups and differences of LVEF, LVEDD among 3 groups were not significant（P 〉0. 05）. At l month and 3 months after PCI, plasma levels of N-proBNP had no significant differences among 3 groups （ P 〉 0. 05 ） ; LVEDD was signifi- cantly lower and LVEF was significantly higher in low and high trimetazidine groups than eontrol group [ （52 ± 4 ）, （51±4）mmvs（58±4）mm;（52±3）,（49±4）mmvs（58±4）mm;（53 ＋5）%,（54＋6）% vs（46＋-6）%; （ 54 ± 5 ） %, （ 55± 5 ） % vs （ 46 ± 5 ） % ] （ all P 〈 0. 05 ） ; differences of LVEF and LVEDD between 2 trimetazidine groups were not significant （ P 〉 0. 05 ）. Conclusion Trimetazidine can help

关 键 词：急性心肌梗死 曲美他嗪 经皮冠状动脉介入治疗 心功能 

分 类 号：R541.4[医药卫生—心血管疾病]