参附注射液预处理联合冠脉内注射前列地尔预防ACS患者急诊PCI术后无复流现象的疗效及机制  

Effect and mechanism of Shenfu injection pretreatment combined with intracoronary injection of alprostadil in preventing no reflow phenomenon after emergency percutaneous coronary intervention in patients with acute coronary syndrome

作　　者：那世敬[1] 李博[1] 魏晓冬[1] 李莹[1] 李大鹏[1] NA Shijing;LI Bo;WEI Xiaodong;LI Ying;LI Dapeng(The First Hospital of Harbin,Harbin 150010,Heilongjiang,China)

机构地区：[1]黑龙江省哈尔滨市第一医院,黑龙江哈尔滨150010

出　　处：《现代中西医结合杂志》2018年第12期1272-1277,共6页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的观察参附注射液预处理联合冠脉内注射前列地尔预防急性冠脉综合征(ACS)患者急诊经皮冠状动脉介入(PCI)术后无复流现象(NRP)的疗效及其机制。方法将120例拟行急诊PCI术的ACS患者随机分为A组、B组和C组,每组40例;A组给予常规PCI治疗,B组在A组基础上于PCI术中(球囊扩张+植入支架前)给予冠脉内注射前列地尔;C组在B组基础上于PCI术前10 min给予参附注射液(1 m L/kg稀释至100m L生理盐水中)静脉输注,并维持静滴至术后24 h。观察各组PCI术前、术后TIMI血流分级、NRP发生率、心肌灌注情况,检测PCI术前、术中、术后炎性因子及血管内皮相关指标水平,记录术后住院期间主要心脏不良事件(MACE)发生率。结果 C组TIMI血流分级显著高于A组、B组(P均<0.05),B组显著高于A组(P均<0.05);C组NRP发生率显著低于A组、B组(P<0.05),B组显著低于A组(P<0.05);3组PCI术后矫正TIMI帧数计数(c TFC)、室壁运动计分指数(WMSI)、心肌灌注缺损计分指数(CSI)较治疗前均显著改善(P均<0.05),C组改善情况显著优于A组、B组(P均<0.05),B组显著优于A组(P<0.05);C组PCI术中、术后的血清hs-CRP、IL-6、ET-1水平均显著低于A组、B组(P均<0.05),B组低于A组(P均<0.05),血清NO则呈现相反趋势。C组住院期间MACE总发生率低于A组、B组(P<0.05),B组显著低于A组(P<0.05)。结论参附注射液预处理联合冠脉内注射前列地尔能够显著降低ACS患者急诊PCI术后NRP的发生率,并显著改善心肌灌注,降低术后MACE发生风险,其机制可能与其抑制炎性反应、保护血管内皮细胞功能有关。Objective:It is to observe the effect and mechanism of Shenfu injection pretreatment combined with intracoronary injection of alprostadil on the prevention of no reflow phenomenon(NRP)after emergency percutaneous coronary intervention(PCI)in patients with acute coronary syndrome(ACS).Methods 0x09 120 patients with ACS were randomly divided into group A,group B and group C,with 40 cases in each group.Group A was given routine treatment of PCI.Group B was injected with alprostadil on the basis of the group A in PCI surgery(balloon dilation+implantation of stent).On the basis of the group B,group C was given intravenous infusion of Shenfu Injection(1 mL/kg diluted to 100 mL normal saline)before PCI and maintained intravenous drip to 24-hour after operation.The classification of TIMI blood flow,the incidence of NRP and the myocardial perfusion were observed before and after PCI,the levels of inflammatory factors and vascular endothelial markers were measured before,during and after PCI,the incidence of major adverse cardiac events(MACE)during hospitalization was recorded.Results 0x09 The blood flow classification of TIMI in the group C was significantly higher than that in the group A and B(P<0.05),and that in the group B was significantly higher than the group A(P<0.05).The incidence of NRP in the group C was significantly lower than that in the group A and B(P<0.05),and that in the group B was significantly lower than the group A(P<0.05).The corrected TIMI frame count(cTFC)and wall motion score index(WMSI),contrast perfusion deficient score index(CSI)of the 3 groups after PCI were significantly improved(all P<0.05),and those in the group C were improved significantly better than the group A and B(all P<0.05),those in the group B was significantly higher than the group A(all P<0.05);the serum levels of hs-CRP,IL-6 and ET-1 during and after PCI in the group C were significantly lower than those in the group A and B(all P<0.05),and group B was significantly lower than the group A(all P<0.05),while serum B showed an op

关 键 词：参附注射液 前列地尔 急性冠脉综合征 经皮冠状动脉介入 无复流现象 

分 类 号：R541.4[医药卫生—心血管疾病]