重组人脑利钠肽治疗急性ST段抬高型心肌梗死再灌注后早期心律失常的效果及安全性观察  

Effects and Safety of Recombinant Human Brain Natriuretic Peptide on Early Arrhythmia after Acute ST-segment Elevation Myocardial

作　　者：钱海平 QIAN Hai-Ping(Department of Cardiovascular Medicine,General Hospital of Hebi Coal Industry(Group)Co.,Ltd.,Hebi 45S000,China)

机构地区：[1]鹤壁煤业(集团)有限责任公司总医院心血管内科,鹤壁458000

出　　处：《中国合理用药探索》2020年第3期47-51,共5页Chinese Journal of Rational Drug Use

摘　　要：目的:探讨重组人脑利钠肽(rh BNP)改善急性ST段抬高型心肌梗死(STEMI)再灌注后早期心律失常的效果及安全性。方法:选取2017年1月~2018年12月间收治的86例行经皮冠状动脉介入术(PCI)的STEMI患者作为研究对象,采用随机数表法将患者分为观察组和对照组(n=43)。对照组给予常规治疗,观察组在此基础上增加rhBNP治疗。比较两组PCI手术疗效及术后24 h内再灌注心律失常发生率,评估术前、术后24 h、术后72 h患者心肌酶谱[肌酸激酶同工酶(CK-MB)、天门冬氨酸氨基转移酶(AST)、肌酸激酶(CK)]、氧化应激指标[髓过氧化物酶(MPO)、超氧化物歧化酶(SOD)、丙二醛(MDA)]的变化情况,评估治疗前及治疗3个月后心室重构情况指标[左心室舒张末内径(LVEDD)、左心室收缩末内径(LVESD)、左室射血分数(LVEF)]。结果:①两组TIMI血流分级2级以上者占比无统计学差异(P>0.05);术后24 h内,观察组窦性心动过缓、窦性停搏、室性心动过速、频发室早、心室颤动、二度以上房室传导阻滞发生率均在统计学上低于对照组(P<0.05)。②术后24 h及72 h时,两组CK-MB、AST、CK均呈先上升后下降趋势(P<0.05),观察组在各时间点各指标水平均低于对照组(P<0.05),不同时间CK-MB、AST、CK与不同用药方案间存在交互效应(P<0.05)。③术后24 h和72 h时,两组MPO、MDA均持续下降(P<0.05),两组SOD均持续上升(P<0.05);观察组各指标变化幅度均大于对照组(P<0.05);不同时间MPO、MDA、SOD与不同方案间存在交互效应(P<0.05)。④治疗3个月后,两组LVEDD、LVESD均低于治疗前(P<0.05),两组LVEF均高于治疗前(P<0.05),观察组各指标变化幅度显著大于对照组(P<0.05)。结论:rhBNP有利于降低STEMI再灌注后心肌损伤和心律失常发生率,并有利于改善患者术后心室重构。Objective:To explore the effects and safety of recombinant human brain natriuretic peptide(rhBNP)on patients with early arrhythmia after acute ST-segment elevation myocardial infarction(STEMI)reperfusion.Methods:Eighty-six patients with STEMI who underwent percutaneous coronary intervention(PCI)between January 2017 and December 2018 were selected as study subjects.The patients were divided into observation group and control group according to the random number table method,with 43 cases in each group.Control group was given routine treatment,while observation group was additionally given rh BNP on this basis.The efficacy of PCI procedure and incidence rate of reperfusion arrhythmia within 24 h after surgery were compared between the two groups.The myocardial enzymes[creatine kinase isoenzyme(CK-MB),aspartate aminotransferase(AST),creatine kinase(CK)]and oxidative stress related factors[myeloperoxidase(MPO),superoxide dismutase(SOD),malondialdehyde(MDA)]were evaluated before surgery,24 h and 72 h post operation.Ventricular remodeling factors[left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular ejection fraction(LVEF)]were assessed before and 3 months post operation.Results:There was no significant difference in the proportion of patients with TIMI blood flow grade 2 or higher between the two groups(P>0.05).Within 24 h post operation,the incidence rates of sinus bradycardia,sinus arrest,ventricular tachycardia,frequent premature ventricular contraction,ventricular fibrillation and seconddegree or above atrioventricular block in the observation group were lower than those in control group(P<0.05).At24 h and 72 h post operation,the levels of CK-MB,AST and CK were increased first and then decreased in both groups(P<0.05),and the levels of these factors in observation group were lower than those in control group at each time point(P<0.05).There were interaction effects between CK-MB,AST and CK at different times points and different medication regimens(P<0.05).At

关 键 词：急性ST段抬高型心肌梗死 经皮冠状动脉介入术 心律失常 重组人脑利钠肽 

分 类 号：R972[医药卫生—药品]