山莨菪碱与维拉帕米治疗急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后无复流现象的有效性及安全性的对比研究  

Effectiveness and Safety of Anisodamine and Verapamil in the Treatment of No-reflow Phenomenon after PCI in Patients with Acute ST Segment Elevation Myocardial Infarction:a Comparative Study

作　　者：邓利华 甘亚 吴彬 邓静 文俊杰 DENG Lihua;GAN Ya;WU Bin;DENG Jing;WEN Junjie(Department of Pharmacy,Guang'an People's Hospital/West China-Guang'an Hospital,Sichuan University,Guang'an 638000,China;Department of Cardiology,Guang'an People's Hospital/West China-Guang'an Hospital,Sichuan University,Guang'an 638000,China)

机构地区：[1]四川省广安市人民医院四川大学华西广安医院药剂科,638000 [2]四川省广安市人民医院四川大学华西广安医院心内科,638000

出　　处：《实用心脑肺血管病杂志》2020年第9期105-109,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：四川省医学科研青年创新课题(Q16030)。

摘　　要：背景近年来,无复流现象已成为经皮冠状动脉介入治疗(PCI)后较为棘手的并发症。目前,临床上主要采用维拉帕米治疗PCI后无复流现象,近年也有采用山莨菪碱治疗无复流现象的研究报道,但二者治疗PCI后无复流现象的效果孰优尚未明确。目的比较山莨菪碱与维拉帕米治疗急性ST段抬高型心肌梗死(ASTEMI)患者PCI后无复流现象的有效性及安全性,以为ASTEMI患者PCI后无复流现象的药物选择提供一定参考。方法选取2018年3月—2019年3月在广安市人民医院行PCI并发生无复流现象的ASTEMI患者160例,采用随机数字表法分为观察组和对照组,每组80例。在硝酸甘油治疗基础上,对照组给予维拉帕米治疗,观察组给予山莨菪碱治疗。比较两组患者治疗前及治疗后1个月炎性指标〔血清白介素6(IL-6)、P-选择素、超敏C反应蛋白(hs-CPR)、细胞间黏附分子(ICAM-1)水平〕、PCI后心肌灌注情况〔无复流现象恢复时间、TIMI血流分级及心肌血流灌注分级(TMPG)〕、治疗前及治疗后1个月心功能指标〔左心室舒张末期内径(LVEDD)及左心室射血分数(LVEF)〕、治疗效果及不良反应发生情况。结果治疗后1个月观察组患者血清IL-6、P-选择素、hs-CRP、ICAM-1水平低于对照组(P<0.05)。治疗后1个月两组患者血清IL-6、P-选择素、hs-CRP、ICAM-1水平分别低于本组治疗前(P<0.05)。观察组患者无复流现象恢复时间短于对照组,TIMI血流分级3级、TMPG 2~3级者所占比例高于对照组(P<0.05)。观察组患者治疗后1个月LVEDD短于对照组,LVEF高于对照组(P<0.05)。治疗后1个月两组患者LVEDD分别短于本组治疗前,LVEF分别高于本组治疗前(P<0.05)。观察组患者ST段回落情况、治疗效果优于对照组(P<0.05)。治疗期间,观察组患者不良反应发生率为5.0%(4/80),对照组为6.2%(5/80),差异无统计学意义(P>0.05)。结论与维拉帕米相比,山莨菪碱能更有效地提高ASTEMI患�Background In recent years,no-reflow phenomenon has become a more difficult complication after percutaneous coronary intervention(PCI).At present,verapamil is mainly used in the treatment of no-reflow phenomenon after PCI,anisodamine has been used to treat no-reflow phenomenon after PCI.However,the treatment effect of anisodamine and verapamil in treatment of no-reflow phenomenon after PCI is not clear.Objective To compare the effectiveness and safety of anisodamine and verapamil in the treatment of no-reflow phenomenon after PCI in patients with acute ST segment elevation myocardial infarction(ASTEMI),which can provide some reference for the drug selection of ASTEMI patients with noreflow phenomenon after PCI.Methods A total of 160 ASTEMI patients with no-reflow phenomenon after PCI in Guang'an People's Hospital from March 2018 to March 2019 were selected,and they were divided into observation group and control group according to random number table method,with 80 cases in each group.On the basis of nitroglycerin treatment,the control group was treated with verapamil,and the observation group was treated with anisodamine.The inflammatory indexes(serum IL-6,P-selectin,hs-CPR,ICAM-1 levels)before and 1 month after treatment,myocardial perfusion after PCI〔noreflow phenomenon recovery time,TIMI blood flow classification and myocardial perfusion classification(TMPG)〕,and the cardiac function indexes(LVEDD and LVEF)before and 1 month after treatment,treatment effect and incidence of adverse reactions were compared between the two groups.Results 1 month after treatment,the serum levels of IL-6,P-selectin,hs-CRP and ICAM-1 in the observation group were lower than those in the control group(P<0.05).1 month after treatment,the serum levels of IL-6,P-selectin,hs-CRP and ICAM-1 in the two groups were lower than those before treatment,respectively(P<0.05).No-reflow phenomenon recovery time in the observation group was shorter than that in the control group,and the proportion of patient with TIMI blood flow grade 3 and TM

关 键 词：心肌梗死 山莨菪碱 维拉帕米 无复流现象 心肌灌注 治疗结果 对比研究 

分 类 号：R542.22[医药卫生—心血管疾病]