中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2010年
2期
121-126
,共6页
刘洋%邓兵%许嘉鸿%李艳延%徐文俊%蒋金法
劉洋%鄧兵%許嘉鴻%李豔延%徐文俊%蔣金法
류양%산병%허가홍%리염연%서문준%장금법
丹参多酚酸盐%急性心肌梗死%血管成形术,经皮冠状动脉%无复流现象
丹參多酚痠鹽%急性心肌梗死%血管成形術,經皮冠狀動脈%無複流現象
단삼다분산염%급성심기경사%혈관성형술,경피관상동맥%무복류현상
polydanshinolate%Acute myocardial infarction%Percutaneous coronary artery angioplasty%no reflow
目的 急性心肌梗死患者直接经皮冠状动脉介入治疗(PCI)加丹参多酚酸盐与直接PCI术加常规药物治疗对照相比,是否可以减少无再流,改善心肌微循环,是否可以改善术后6个月的心室重构以及临床终点的影响.方法 随机、平行对照、前瞻性临床研究,入选因首次急性ST段抬高型心肌梗死入院,适合并同意行直接PCI术的患者60例,随机分成2组,直接PCI术+丹参多酚酸盐组30例(A组),直接PCI术+常规药物治疗组30例(B组),随访至术后6个月.采用ST段抬高总和回落百分比(sum STR)、校正的TIMI帧数计数(CTFC)、心肌声学造影检查(MCE)等多种方法评价心肌灌注.观察住院及随访期间患者出血事件、心功能以及心血管事件的发生.结果 2组基础临床情况、急诊CAG结果及急诊PCI置入支架情况差异均无统计学意义(P均>0.05).A组与B组相比,术后TIMI 3级血流发生率高(90.0%与63.3%,χ~2= 4.565,P=0.0326);A组术后1 h心电图平均sum STR≥70%明显高于B组(80.0%与50.0%,χ~2=4.689, P=0.0304);术后CTFC分别为(24.1±8.3)帧与(33.4±15.9)帧,差异有统计学意义(P=0.0062).2组局部心肌血流量(MBF)术后48 h相比无明显差异(P均>0.05),但术后7 d 2组均有明显增加(5.85±1.26与2.09±1.85,t=9.2008,P<0.0001;3.95±1.35与1.95±1.29,t=5.8666,P<0.0001),并且组间比较差异亦有统计学意义(P<0.01).2组在住院期间以及6个月随访左室射血分数(LVEF)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)相比无明显差异(P均>0.05).住院及随访期间严重心力衰竭发生率,A组低于B组,差异有统计学意义(P<0.05).结论 丹参多酚酸盐可以减少急性心肌梗死患者直接PCI中无复流现象的发生,改善心肌再灌注,减少心脏不良事件改善预后.
目的 急性心肌梗死患者直接經皮冠狀動脈介入治療(PCI)加丹參多酚痠鹽與直接PCI術加常規藥物治療對照相比,是否可以減少無再流,改善心肌微循環,是否可以改善術後6箇月的心室重構以及臨床終點的影響.方法 隨機、平行對照、前瞻性臨床研究,入選因首次急性ST段抬高型心肌梗死入院,適閤併同意行直接PCI術的患者60例,隨機分成2組,直接PCI術+丹參多酚痠鹽組30例(A組),直接PCI術+常規藥物治療組30例(B組),隨訪至術後6箇月.採用ST段抬高總和迴落百分比(sum STR)、校正的TIMI幀數計數(CTFC)、心肌聲學造影檢查(MCE)等多種方法評價心肌灌註.觀察住院及隨訪期間患者齣血事件、心功能以及心血管事件的髮生.結果 2組基礎臨床情況、急診CAG結果及急診PCI置入支架情況差異均無統計學意義(P均>0.05).A組與B組相比,術後TIMI 3級血流髮生率高(90.0%與63.3%,χ~2= 4.565,P=0.0326);A組術後1 h心電圖平均sum STR≥70%明顯高于B組(80.0%與50.0%,χ~2=4.689, P=0.0304);術後CTFC分彆為(24.1±8.3)幀與(33.4±15.9)幀,差異有統計學意義(P=0.0062).2組跼部心肌血流量(MBF)術後48 h相比無明顯差異(P均>0.05),但術後7 d 2組均有明顯增加(5.85±1.26與2.09±1.85,t=9.2008,P<0.0001;3.95±1.35與1.95±1.29,t=5.8666,P<0.0001),併且組間比較差異亦有統計學意義(P<0.01).2組在住院期間以及6箇月隨訪左室射血分數(LVEF)、左室舒張末期容積(LVEDV)、左室收縮末期容積(LVESV)相比無明顯差異(P均>0.05).住院及隨訪期間嚴重心力衰竭髮生率,A組低于B組,差異有統計學意義(P<0.05).結論 丹參多酚痠鹽可以減少急性心肌梗死患者直接PCI中無複流現象的髮生,改善心肌再灌註,減少心髒不良事件改善預後.
목적 급성심기경사환자직접경피관상동맥개입치료(PCI)가단삼다분산염여직접PCI술가상규약물치료대조상비,시부가이감소무재류,개선심기미순배,시부가이개선술후6개월적심실중구이급림상종점적영향.방법 수궤、평행대조、전첨성림상연구,입선인수차급성ST단태고형심기경사입원,괄합병동의행직접PCI술적환자60례,수궤분성2조,직접PCI술+단삼다분산염조30례(A조),직접PCI술+상규약물치료조30례(B조),수방지술후6개월.채용ST단태고총화회락백분비(sum STR)、교정적TIMI정수계수(CTFC)、심기성학조영검사(MCE)등다충방법평개심기관주.관찰주원급수방기간환자출혈사건、심공능이급심혈관사건적발생.결과 2조기출림상정황、급진CAG결과급급진PCI치입지가정황차이균무통계학의의(P균>0.05).A조여B조상비,술후TIMI 3급혈류발생솔고(90.0%여63.3%,χ~2= 4.565,P=0.0326);A조술후1 h심전도평균sum STR≥70%명현고우B조(80.0%여50.0%,χ~2=4.689, P=0.0304);술후CTFC분별위(24.1±8.3)정여(33.4±15.9)정,차이유통계학의의(P=0.0062).2조국부심기혈류량(MBF)술후48 h상비무명현차이(P균>0.05),단술후7 d 2조균유명현증가(5.85±1.26여2.09±1.85,t=9.2008,P<0.0001;3.95±1.35여1.95±1.29,t=5.8666,P<0.0001),병차조간비교차이역유통계학의의(P<0.01).2조재주원기간이급6개월수방좌실사혈분수(LVEF)、좌실서장말기용적(LVEDV)、좌실수축말기용적(LVESV)상비무명현차이(P균>0.05).주원급수방기간엄중심력쇠갈발생솔,A조저우B조,차이유통계학의의(P<0.05).결론 단삼다분산염가이감소급성심기경사환자직접PCI중무복류현상적발생,개선심기재관주,감소심장불량사건개선예후.
Objective To compare the effect of percutaneons coronary interventions (PCI) combined with polydanshinolate on myocardial reperfusion with PCI combined with regular medicine in patients with acute myocardi-al infrarction ,and whether polydanshinolate would decrease no-reflow,improve the myocardial micro-circulation and the ventricular remodeling and clinical end-point events at the sixth month. Methods Random,parallel control and prospective clinical design was used in the current study. Sixty eligible patients for PCI, who were diagnosed as first-time acute myocardial infrarction with ST stage increasing,were recruited in the study with informed consent. All par-ticipants were divided into two groups randomly. Group A was treated with PCI combined with polydanshinolate, group B was treated with PCI combined with regular medicine. The participants were followed up for six months. The resolution of the sum of ST segment elevation (sum STR) ,corrected TIMI frame count (CTFC) and myocardial con-trast echocardiography (MCE) were used to assess myocardial perfusion. Bleeding events, heart function and major adverse cardiac events (MACE) were observed during hospitalization and follow-up visit. Results No significant difference was observed between two groups on the clinical condition and the results of emergency CAG and PCI. Compared to group B,the incidence of TIMI grade 3 was significantly higher in group A (90.0% vs 63.3% ,χ~2 = 4.565, P=0.0326). Sum STR one hour after PCI in group A was siguificanfly higher than that in group B (80.0% vs 50.0%, χ~2=4.689, P=0.0304). CTFC after PCI also differed significantly between the two groups (24.1±8.3 vs 33.4±15.9 respectively,P=0.0062). Localized myocardial blood flow 48 hours after PCI showed no significant difference between the two groups (P>0.05), whereas both increased at the 7th day after PCI (5.85±1.26 vs 2.09±1.85,t=9.2008,P<0.0001 ;3.95±1.35 vs 1.95±1.29,t=5.8666,P<0.0001) ,and there were signifi-cant difference between the two groups (P<0.05). No significant difference of LVEF, LVEDV, LVESV were found between the two groups during the hospitalization and follow-up visit after 6 months (P>0.05). The incidences of cardiovascular events and severe heart failure during hospitalization and follow-up visit in group A were significantly lower than that in group B (P<0.05 ). Conclusions Polydanshinolate addition to PCI could reduce no reflow phe-nomenan in patients of acute myocardial infrarction, improve myocardial reperfusion, and furthermore, decrease cardi-ovascular events and ameliorate prognosis.
