乌司他丁对老年急性心肌梗死急诊溶栓患者心肌有保护作用  

Effects of ulinastatin on myocardial enzymes oxidative stress and short-term prognosis in elderly patients with acute myocardial infarction undergoing emergency thrombolysis

作　　者：吴松[1] 金肇权[1] 孙丹[1] 朱明慧[1] WU Song;JIN Zhao-quan;SUN Dan;ZHU Ming-hui(Department of Emergency,Changzhou First People's Hospital,Jiangsu Changzhou 213003,China)

机构地区：[1]常州市第一人民医院急诊科,江苏常州213003

出　　处：《内科急危重症杂志》2022年第4期294-296,300,共4页Journal of Critical Care In Internal Medicine

摘　　要：目的:探讨乌司他丁对老年急性心肌梗死(AMI)急诊溶栓患者心肌酶谱、氧化应激、炎性反应、心功能及近期预后的影响。方法:根据非随机临床同期对照研究及患者自愿原则将150例老年AMI患者分为对照组(急诊溶栓治疗)和观察组(在对照组基础上联合乌司他丁治疗)各75例,比较2组治疗前、后心肌酶谱、氧化应激、炎性反应、心功能指标及治疗后30 d内主要不良心血管事件(MACE)发生率。结果:治疗前2组心肌肌钙蛋白Ⅰ(cTnI)、肌酸激酶同工酶(CK-MB)、还原型谷胱甘肽(GSH)、超氧化物歧化酶(SOD)、丙二醛(MDA)、白介素(IL)-6、超敏C反应蛋白(hsCRP)、左心室舒张末期内径(LVEDD)、左室射血分数(LVEF)比较,差异无统计学意义(P均>0.05);治疗后48、72 h观察组hs-cTnT、CK-MB、MDA、IL-6、hsCRP水平和LVEDD较对照组低(P均<0.05),GSH、SOD水平和LVEF较对照组高(P均<0.05)。观察组治疗后30d内MACE发生率较对照组低(P<0.05)。结论:乌司他丁对老年AMI患者再灌注心肌有保护作用,可明显降低治疗后30 d内MACE发生率。Objective:To explore effects of ulinastatin on myocardial enzymes,oxidative stress,inflammatory response,cardiac function and short-term prognosis in elderly patients with acute myocardial infarction(AMI)undergoing emergency thrombolysis.Methods:According to the non-randomized clinical concurrent control study and voluntary principle of patients,150 elderly AMI patients were divided into control group(emergency thrombolysis)and observation group(thrombolysis combined with ulinastatin),75 cases in each group.Myocardial enzymes,oxidative stress,inflammatory response and cardiac function indexes before and after treatment,and incidence of major adverse cardiovascular events(MACEs)within30 days after treatment were compared between the two groups.Results:Before treatment,there was no significant difference in myocardial troponin I(cTnI),creatine kinase isoenzyme(CK-MB),reduced glutathione(GSH),superoxide dismutase(SOD),malondialdehyde(MDA),interleukin-6(IL-6),high-sensitivity C-reactive protein(hsCRP),left ventricular enddiastolic diameter(LVEDD)or left ventricular ejection fraction(LVEE)between the two groups(P>0.05).After 48 h and 72 h of treatment,hs-cTnT,CK-MB,MDA,IL-6,hsCRP and LVEDD in observation group were significantly lower(P<0.05),and GSH,SOD and LVEF were significantly higher(P<0.05)than those in the control group.In addition,incidence of MACEs within 30 days after treatment in observation group was significantly lower than that in control group(P<0.05).Conclusion:Compared with routine emergency thrombolysis,protective effect of ulinastatin combined with emergency thrombolysis is more significant on reperfusion injury myocardium in elderly AMI patients.The latter can significantly reduce incidence of MACEs within 30 days after treatment.The specific mechanism may be related to that ulinastatin can effectively inhibit body oxidative stress and inflammatory response thus improving cardiac function.

关 键 词：急性心肌梗死 急诊溶栓 乌司他丁 心肌酶谱 氧化应激 预后 

分 类 号：R542.22[医药卫生—心血管疾病]