急性前壁心肌梗死患者急诊经皮冠脉介入术后主动脉内球囊反搏与重组人脑利钠肽对心功能的保护作用  

Combined application of IABP and rhBNP in patients with acute anterior ST⁃segment elevation myocardial infarction undergoing emergency percutaneous coronary intervention

作　　者：马贵洲[1] 徐荣和[1] 周琳洁 蔡志雄[1] 郑海生[1] 郭海森[1] 许志浩 陈钢彬 倪楚民[1] 王莹[1] MA Guizhou;XU Ronghe;ZHOU Linjie;CAI Zhixiong;ZHENG Haisheng;GUO Haisen;XU Zhihao;CHEN Gangbin;NI Chumin;WANG Ying(Department of Cardiology,Shantou Central Hospital,Shantou 515031,China)

机构地区：[1]汕头市中心医院心内科,广东汕头515031

出　　处：《实用医学杂志》2022年第21期2720-2726,共7页The Journal of Practical Medicine

基　　金：2019年汕头市第六批医疗卫生科技计划项目(编号:汕府科[2020]5号-8)。

摘　　要：目的探讨急性前壁心梗患者在急诊冠脉介入(PCI)的基础上,联合应用主动脉内球囊反搏(IABP)与重组人脑利钠肽(rhBNP)对心功能的影响。方法分析2019年8月至2020年12月入住汕头市中心医院CCU并接受急诊PCI的急性前壁心肌梗死患者,根据应用IABP、rhBNP情况分为三组:A组采用IABP联合rhBNP,B组仅采用IABP,C组仅采用rhBNP。分析三组之间的心功能、心肌酶指标、平均住院日、住院及随访期间不良事件。结果(1)三组患者血cTNI峰值、血CKMB峰值差异无统计学意义(P>0.05);但血NT⁃proBNP峰值差异有统计学意义(P<0.05);其中A组的血NT⁃proBNP峰值低于B组与C组(P<0.05);(2)三组患者入院24 h内左室舒张末内径(LVDD)及左室射血分数(LVEF)差异无统计学意义(P>0.05);而在出院后6个月,A组的LVDD较B组、C组均缩小,差异有统计学意义(P<0.05)。另外,A组患者在出院后6个月的LVDD较基线水平缩小且LVEF升高,差异有统计学意义(P<0.05),而B组及C组出院后6个月的LVDD及LVEF与基线水平比较差异无统计学意义(P>0.05)。(3)三组患者平均住院日及住院期间不良事件比较差异无统计学意义(P>0.05);(4)随访期间发生需住院的心衰:A组为1例(2.17%)、B组为5例(17.86%)、C组为1(5.88%),三组间存在差异有统计学意义(P<0.05);但在再次血运重建方面差异无统计学意义(P>0.05)。结论对于急性前壁心肌梗死行急诊PCI患者,联合应用IABP与rhBNP可抑制左心室重构、改善心功能,并降低出院后发生需住院心衰概率。Objective To investigate the effects of IABP in combination with rhBNP in patients undergo⁃ing emergency percutaneous coronary intervention(PCI)for acute anterior myocardial infarction.Methods The study included 91 patients who had an acute anterior myocardial infarction and needed emergency PCI.They were divided into three groups based on the application of IABP and rhBNP:group A received IABP combined with rhBNP,group B received IABP,and group C received rhBNP.Cardiac function index,average length of stay,adverse events during hospitalization and post⁃discharge follow⁃up were all examined.Results(1)the peak NT⁃proBNP concentration in group A was lower than that in group B and C(P<0.05).(2)There were no significant differences in LVDD or LVEF among the three groups at admission(P>0.05).During the follow⁃up,LVDD in group A was smaller than that in group B and group C(P<0.05).In addition,compared with baseline,the LVDD decreased and LVEF increased in group A at 6 months after discharge(P<0.05).However,there were no statistical differences in LVDD and LVEF between groups B and C when compared to baseline(P>0.05).(3)During hospital⁃ization,the average length of stay and adverse events did not differ statistically(P>0.05).(4)During the follow⁃up period,the incidence of heart failure requiring hospitalization was 2.17%in group A,17.86%in group B,and 5.88%in group C,and the difference was statistically significant(P<0.05).However,there was no significant difference in revascularization among the three groups(P>0.05).Conclusion The combination of IABP and rhBNP can improve cardiac function and reduce the incidence of heart failure requiring hospitalization after dis⁃charge in patients with acute anterior STEMI undergoing emergency PCI.

关 键 词：急性ST段抬高型心肌梗死 急诊经皮冠脉介入术 主动脉内球囊反搏 重组人脑利钠肽 

分 类 号：R541.4[医药卫生—心血管疾病]