冠脉内预防性注射硝普钠对急诊经皮冠状动脉支架植入术患者预后影响  

Effect of intracoronary prophylactic injection of sodium nitroprusside on the prognosis of patients with primary percutaneous coronary intervention

作　　者：黄国鹏[1] 彭晓林 李洪林[1] 曾云洁 周邦健 陈丽华 HUANG Guo-peng;PENG Xiao-lin;LI Hong-lin;ZENG Yun-jie;ZHOU Bang-jian;CHEN Li-hua(Department of Cardiovascular Medicine,Chongqing Dazu People′s Hospital,Chongqing 402360,China)

机构地区：[1]重庆医科大学附属第一医院大足医院重庆市大足区人民医院心血管内科

出　　处：《创伤与急危重病医学》2020年第1期17-20,24,共5页Trauma and Critical Care Medicine

基　　金：重庆市卫生计生委医学科研项目(2017MSXM185)

摘　　要：目的探讨冠状动脉内预防性注射硝普钠对急诊行经皮冠状动脉支架植入术(PCI)患者近期及远期预后的影响。方法选取自2017年1月1日至2018年1月1日收治的因急性ST段抬高型心肌梗死行急诊PCI的患者100例,采用随机数字表法分为A组(n=50)与B组(n=50),其中,B组在血栓抽吸后用抽吸导管预防性注射硝普钠200μg,A组在血栓抽吸后用抽吸导管注射等量生理盐水,再根据患者造影情况行PCI。比较两组患者PCI术前及术后TIMI血流情况,术后低血压、恶性心律失常发生情况,住院期间主要不良心血管事件(MACE),N端前脑钠肽(NT-ProBNP)、C反应蛋白(CRP)水平及左室射血分数(LVEF)。两组患者随访1年后,复查冠脉造影,比较随访过程中两组患者MACE事件、LVEF、全因病死情况。结果术前,两组患者TIMI血流分级情况比较,差异无统计学意义(P>0.05)。PCI术后,B组患者TIMI血流3级患者占96.0%(48/50),明显高于A组的82.0%(41/50),差异有统计学意义(P<0.05)。两组患者支架植入术后并发低血压、恶性心律失常患者比例比较,差异无统计学意义(P>0.05)。B组患者住院期间MACE发生率为2.0%(1/50),明显低于A组的14.0%(7/50),差异有统计学意义(P<0.05)。B组患者LVEF高于A组,NT-ProBNP低于A组,组间比较,差异均有统计学意义(P<0.05)。两组患者CRP水平比较,差异无统计学意义(P>0.05)。患者均随访1年,两组患者全因病死率比较,差异无统计学意义(P>0.05)。B组患者靶血管血运重建率低于A组,差异有统计学意义(P<0.05)。随访1年,A组患者MACE事件发生率为6.0%(3/50),B组患者MACE事件发生率为4.0%(2/50),组间比较,差异无统计学意义(P>0.05)。术后1年,B组患者LVEF为(54.86%±4.79%),高于A组的(53.17%±2.21%),组间比较,差异有统计学意义(P<0.05)。结论患者在介入治疗过程中预防性应用硝普钠可明显减少术后无复流发生,降低院内MACE事件发生率及1年内的靶血管血运重建率,提Objective To investigate the effect of preventive injection of sodium nitroprusside in coronary arteries on the short-term and long-term prognosis of emergency patients undergoing percutaneous coronary intervention(PCI).Methods A retrospective study was performed on 100 cases of patients with acute ST elevation myocardial infarction who were admitted and underwent PCI from January 1st,2017 to January 1st,2018.Patients were randomly divided into the Group A(n=50)and Group B(n=50).In Group B,sodium nitroprusside was injected with an aspiration catheter at 200μg prophylaxis after thrombus aspiration,and in Group A,an equal amount of normal saline was injected with an aspiration catheter after thrombus aspiration,and then PCI was performed according to the angiographic situation of the patients.The blood flow of TIMI before and after PCI,postoperative hypotension,malignant arrhythmia,major adverse cardiovascular events(MACE),N-terminal pro-brain natriuretic peptide(NT-ProBNP),C-reactive protein(CRP)levels and left ventricular ejection fraction(LVEF)were compared between the two groups.Patients in the two groups were followed up for 1 year,and coronary angiography was reexamined to compare MACE events,LVEF and all-cause death in the two groups during the follow-up.Results Before surgery,there was no significant difference in TIMI blood flow grading between the two groups(P>0.05).After PCI,96.0%(48/50)of patients in Group B had TIMI grade 3 blood flow,which was significantly higher than 82.0%(41/50)in Group A(P<0.05).There was no significant difference in the proportion of patients with hypotension and malignant arrhythmia after stent implantation between the two groups(P>0.05).The incidence of MACE in Group B during hospitalization was 2.0%(1/50),which was significantly lower than that in Group A(14.0%,7/50,P<0.05).LVEF in Group B was higher than that in Group A,and NT-ProBNP was lower than that in Group A(P<0.05).There was no significant difference in CRP level between the two groups(P>0.05).Patients in both groups

关 键 词：结直肠肿瘤 术后肠梗阻 原因 对策经皮冠状动脉支架植入术 急性心肌梗死 硝普钠 无复流 预后 

分 类 号：R542.22[医药卫生—心血管疾病]