前壁ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗后早期应用沙库巴曲缬沙坦的临床观察  

Effect of early application of sakubatral valsartan in patients with anterior wall ST-segment elevation myocardial infarction after emergency percutaneous coronary intervention

作　　者：陶辉宇 孙翔 杨浩 艾旗 TAO Hui-yu;SUN Xiang;YANG Hao;AI Qi(The Eighth Hospital of Changsha City,Changsha 410100,China)

机构地区：[1]长沙市第八医院,长沙410100

出　　处：《岭南心血管病杂志》2022年第5期407-410,437,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨前壁ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后早期应用沙库巴曲缬沙坦的应用价值。方法对2019年1月至2020年6月长沙市第八医院176例急性前壁STEMI急诊PCI治疗患者采用随机数字表法分为对照组及观察组。两组患者均采取急诊PCI治疗,治疗后在常规治疗基础上,对照组使用依那普利,观察组使用沙库巴曲缬沙坦,治疗6个月。比较两组患者的脑钠肽(brain natriuretic peptide,BNP)、左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)及主要不良心血管事件(major adverse cardiovascular event,MACE)。结果两组患者基线临床资料比较,差异无统计学意义(P>0.05)。观察组患者血浆BNP浓度于入院后第5天开始显著低于对照组,差异有统计学意义(P<0.05),且随治疗时间延长,效果越明显。术后1周观察组患者LVEF升高、LVEDD缩小开始优于对照组,其中LVEF有显著性差异,第14天时LVEDD开始出现显著性差异,差异有统计学意义(P<0.05),而且两者随着治疗时间延长,效果越明显(P<0.01)。观察组患者6个月期间的MACE发生率较对照组显著下降,差异有统计学意义(P<0.01)。结论对于前壁STEMI急诊PCI治疗患者,早期应用沙库巴曲缬沙坦可以显著降低BNP浓度,提升患者LVEF,降低LVEDD,减少MACE,尤其是心力衰竭发生率,明显改善患者近期预后。Objectives To explore the value of early application of sakuba valsartan in patients with anterior wall STsegment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).Methods From January 2019 to June 2020 in The Eighth Hospital of Changsha City,176 patients with acute anterior wall STEMI after PCI were divided into control group and observation group by random digital table method.Both the two groups were treated with emergency PCI,postoperatively,patients in control group were treated with enalapril and patients in observation group were treated with sakubatral valsartan for 6 months.The brain natriuretic peptide(BNP),left ventric⁃ular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)and incidence of major cardiovascular events(MACE)were compared between the two groups.Results The baseline clinical characteristics of the two groups were not statistically significant(P>0.05).The plasma concentration of BNP in observation group was significantly lower than that in control group(P<0.05)at the 5th day after admission,and the effect was more obvious with the prolongation of the treatment duration.One week after operation,the LVEF and LVEDD of observation group were better than those of control group,but there was no significant difference(P>0.05);After 2 weeks,there was a significant difference(P<0.05),and the effect was more obvious with the prolongation of treatment duration(P<0.01).Incidence of MACE in observation group was significantly lower than that in control group during 6 months after PCI(P<0.01).Conclusions The early application of sakubatral valsartan in patients with anterior wall STEMI after emergency PCI can significantly reduce the BNP concentration,increase LVEF,reduce LVEDD,reduce the incidence of MACE(especially heart failure),and significantly improve the short-term prognosis of patients.

关 键 词：心肌梗死 沙库巴曲缬沙坦 心力衰竭 心肌重构 心血管事件 血管成形术 经腔 经皮冠状动脉 

分 类 号：R542.22[医药卫生—心血管疾病]