中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2010年
8期
807-810
,共4页
要英杰%邵一兵%王旭%王正忠
要英傑%邵一兵%王旭%王正忠
요영걸%소일병%왕욱%왕정충
心肌梗死%远端保护装置%内皮素%肾素%醛固酮%血管紧张素Ⅱ%去甲肾上腺素%肾上腺素
心肌梗死%遠耑保護裝置%內皮素%腎素%醛固酮%血管緊張素Ⅱ%去甲腎上腺素%腎上腺素
심기경사%원단보호장치%내피소%신소%철고동%혈관긴장소Ⅱ%거갑신상선소%신상선소
Myocardial infarction%Distal protection device%Endothelin%Plasma renin activity%Aldosterone%AngiotensinⅡ%Norepinephrine%Epinephrine
目的 探讨急性ST段抬高性心肌梗死(STEMI)急诊经皮冠状动脉成形术(PCI)中应用远端保护装置对神经内分泌指标的影响及其临床价值.方法 本研究为前瞻性对照研究,将2004年9月至2006年12月在青岛市市立医院行急诊PCI的72例STEMI患者随机(随机数字法)分为远端保护组(GW)和非远端保护组(NGW).入选标准:发病在6 h之内,胸痛持续≥30 min且用硝酸甘油不缓解;在12导联心电图上至少有2个相邻导联ST-段抬高≥0.2 mV;梗死相关血管(IRA)近段或中段直径≥3 mm;血浆中的肌酸激酶增高.排除标准为:血流动力学状态不稳定者;严重心功能不全;多支血管病变拟行冠状动脉搭桥者;左主干病变;急性心肌梗死机械并发症.于术前、术后1 d,2 d,3 d,5 d分别测定外周血中内皮素(ET)、血浆肾索活性(PRA)、醛固酮(ALD)、血管紧张素Ⅱ(Ang Ⅱ)、去甲肾上腺素(NE)、肾上腺素(E)水平.分别对术后1,2,3,5 d的ET,PRA,ALD,AngⅡ,NE,E等数值应用成组t检验进行两组间的比较.结果 两组病例均成功植入支架,术前两组患者的神经内分泌因子水平差异无统计学意义(P＜0.05).GW组较NGW组ET,PRA,ALD,AngⅡ,NE,E等神经内分泌因子水平于术后第1天下降明显,两组差异具有统计学意义(P＜0.05).结论 急性心肌梗死急诊PCI手术中应用远端保护装置可以使神经内分泌指标降低,减少其不利影响,促进心肌的恢复.
目的 探討急性ST段抬高性心肌梗死(STEMI)急診經皮冠狀動脈成形術(PCI)中應用遠耑保護裝置對神經內分泌指標的影響及其臨床價值.方法 本研究為前瞻性對照研究,將2004年9月至2006年12月在青島市市立醫院行急診PCI的72例STEMI患者隨機(隨機數字法)分為遠耑保護組(GW)和非遠耑保護組(NGW).入選標準:髮病在6 h之內,胸痛持續≥30 min且用硝痠甘油不緩解;在12導聯心電圖上至少有2箇相鄰導聯ST-段抬高≥0.2 mV;梗死相關血管(IRA)近段或中段直徑≥3 mm;血漿中的肌痠激酶增高.排除標準為:血流動力學狀態不穩定者;嚴重心功能不全;多支血管病變擬行冠狀動脈搭橋者;左主榦病變;急性心肌梗死機械併髮癥.于術前、術後1 d,2 d,3 d,5 d分彆測定外週血中內皮素(ET)、血漿腎索活性(PRA)、醛固酮(ALD)、血管緊張素Ⅱ(Ang Ⅱ)、去甲腎上腺素(NE)、腎上腺素(E)水平.分彆對術後1,2,3,5 d的ET,PRA,ALD,AngⅡ,NE,E等數值應用成組t檢驗進行兩組間的比較.結果 兩組病例均成功植入支架,術前兩組患者的神經內分泌因子水平差異無統計學意義(P＜0.05).GW組較NGW組ET,PRA,ALD,AngⅡ,NE,E等神經內分泌因子水平于術後第1天下降明顯,兩組差異具有統計學意義(P＜0.05).結論 急性心肌梗死急診PCI手術中應用遠耑保護裝置可以使神經內分泌指標降低,減少其不利影響,促進心肌的恢複.
목적 탐토급성ST단태고성심기경사(STEMI)급진경피관상동맥성형술(PCI)중응용원단보호장치대신경내분비지표적영향급기림상개치.방법 본연구위전첨성대조연구,장2004년9월지2006년12월재청도시시립의원행급진PCI적72례STEMI환자수궤(수궤수자법)분위원단보호조(GW)화비원단보호조(NGW).입선표준:발병재6 h지내,흉통지속≥30 min차용초산감유불완해;재12도련심전도상지소유2개상린도련ST-단태고≥0.2 mV;경사상관혈관(IRA)근단혹중단직경≥3 mm;혈장중적기산격매증고.배제표준위:혈류동역학상태불은정자;엄중심공능불전;다지혈관병변의행관상동맥탑교자;좌주간병변;급성심기경사궤계병발증.우술전、술후1 d,2 d,3 d,5 d분별측정외주혈중내피소(ET)、혈장신색활성(PRA)、철고동(ALD)、혈관긴장소Ⅱ(Ang Ⅱ)、거갑신상선소(NE)、신상선소(E)수평.분별대술후1,2,3,5 d적ET,PRA,ALD,AngⅡ,NE,E등수치응용성조t검험진행량조간적비교.결과 량조병례균성공식입지가,술전량조환자적신경내분비인자수평차이무통계학의의(P＜0.05).GW조교NGW조ET,PRA,ALD,AngⅡ,NE,E등신경내분비인자수평우술후제1천하강명현,량조차이구유통계학의의(P＜0.05).결론 급성심기경사급진PCI수술중응용원단보호장치가이사신경내분비지표강저,감소기불리영향,촉진심기적회복.
Objective To study changes of neuroendocrine in patients with ST segment elevation acute myocardial infarction (STEMI) after using distal protection device (GuardWire PlusTM). Method Seventy patients with STEMI received percutaneous coronary intervention (PCI) in Municipal Hospital Qingdao, during September 2004 to December 2006. They were randomdy (random numbs) enrolled in this prospective and control study. All the patients were divided into 2 groups: the distal protection device group (GW) and the non-distal protection device group (NGW).The inclusion criteria were:onset within 6 hours, chest pain more than 30 minutes without response to nitroglycerin, two or more adjacent ST segnents elevated over 0.2 mv,the proximal or middle diameter of infarction artery over 3 mm, and the increased plasma creatine kinase. The exclusion criteria were fluctuation in hemodynamics, severe heart failure, arteriopathy of left main coronary artery, mechanical complications of acute myocardial infarction and multi-vessel disease scheduled for coronary artery bypass. The plasma levels of endothelin(ET) , plasma renin activity (PRA),aldosterone (ALD),angiotensin Ⅱ (Ang Ⅱ), norepinephrine (NE) and epinephrine (E) were measured on the day of operation and on the 1st,2nd,3rd and 5th day after operation, respectively. The t-test was used to compare those neuroendocrine elements between two groups. Results There were no differences in plasma levels of all the neuroendocrine elements between two groups before operation. Compared with the NGW group, the levels of neuroendocrine elements in the plasma rapidly decreased in the GW group at 1 d after the operation ( P ＜ 0.05). Conclusions In patients with ST segment elevation acute myocardial infarction, the distal protection device can decrease the changes in neuroendocrine.
