中国全科医学
中國全科醫學
중국전과의학
Chinese General Practice
2015年
35期
4283-4287
,共5页
陈章强%戴军%姚民%洪浪%王洪
陳章彊%戴軍%姚民%洪浪%王洪
진장강%대군%요민%홍랑%왕홍
急性冠脉综合征%经皮冠状动脉介入治疗%无复流现象%地尔硫卓艹%硝普钠%疗效比较研究
急性冠脈綜閤徵%經皮冠狀動脈介入治療%無複流現象%地爾硫卓艸%硝普鈉%療效比較研究
급성관맥종합정%경피관상동맥개입치료%무복류현상%지이류탁초%초보납%료효비교연구
Acute coronary syndrome%Percutaneous coronary intervention%No -reflow phenomenon%Diltiazem%Nitroprusside%Comparative effectiveness research
目的：比较地尔硫卓艹和硝普钠在改善急性冠脉综合征（ ACS）患者经皮冠状动脉介入（ PCI）治疗中无复流现象的效果。方法选取2008年1月—2014年6月于江西省人民医院接受PCI治疗且术中出现无复流现象的ACS患者80例为研究对象，采用随机数字表法将患者分为地尔硫卓艹组（40例）和硝普钠组（40例）。两组于PCI术中经微导管冠状动脉靶病变远端2 s内“弹丸式”快速分别给予地尔硫卓艹、硝普钠200~600μg，分别于给药后10、20 min后复查冠状动脉造影，评价心肌梗死溶栓治疗（ TIMI）血流分级和校正的TIMI血流帧数（ CTFC），同时记录给药前及给药后10、20 min有创血压及心率的变化。分别于PCI术前及术后7、30 d记录左心室收缩末内径（ LVESD）、左心室舒张末内径（ LVEDD）及左心室射血分数（ LVEF）。于 PCI 术前及术后7、30 d 测定 N 末端 B 型脑钠肽前体（NT-proBNP）及细胞因子超敏C反应蛋白（hs-CRP）、白介素6（IL-6）及细胞间黏附分子-1（ICAM-1）水平。记录两组术后30 d内主要心血管事件（再发心绞痛、再发急性心肌梗死及心力衰竭发作）和其他心血管事件（恶性心律失常及猝死）的发生情况。结果不同药物对TIMI血流分级、CTFC、收缩压、舒张压及心率的影响比较，差异无统计学意义（P﹥0.05）。两组用药后10、20 min TIMI血流分级、CTFC与用药前比较，差异有统计学意义（P﹤0.05）。不同药物对LVESD、LVEDD、LVEF 的影响比较，差异无统计学意义（ P ﹥0.05）。两组术后30 d LVESD、LVEDD及LVEF与术前比较，差异有统计学意义（ P﹤0.05）。不同药物对NT-proBNP、hs-CRP、IL-6及ICAM-1的影响比较，差异无统计学意义（ P﹥0.05）。两组术后7、30 d NT-proBNP、hs-CRP、IL-6、ICAM-1水平均低于术前，差异有统计学意义（ P﹤0.01）。两组术后30 d内主要心血管事件及其他心血管事件发生率比较，差异均无统计学意义（P﹥0.05）。结论地尔硫卓艹和硝普钠均能够有效改善 PCI 术中 TIMI 血流分级及 CTFC，降低炎性因子和NT-proBNP水平，改善心功能，两者改善无复流现象的效果相当。
目的：比較地爾硫卓艸和硝普鈉在改善急性冠脈綜閤徵（ ACS）患者經皮冠狀動脈介入（ PCI）治療中無複流現象的效果。方法選取2008年1月—2014年6月于江西省人民醫院接受PCI治療且術中齣現無複流現象的ACS患者80例為研究對象，採用隨機數字錶法將患者分為地爾硫卓艸組（40例）和硝普鈉組（40例）。兩組于PCI術中經微導管冠狀動脈靶病變遠耑2 s內“彈汍式”快速分彆給予地爾硫卓艸、硝普鈉200~600μg，分彆于給藥後10、20 min後複查冠狀動脈造影，評價心肌梗死溶栓治療（ TIMI）血流分級和校正的TIMI血流幀數（ CTFC），同時記錄給藥前及給藥後10、20 min有創血壓及心率的變化。分彆于PCI術前及術後7、30 d記錄左心室收縮末內徑（ LVESD）、左心室舒張末內徑（ LVEDD）及左心室射血分數（ LVEF）。于 PCI 術前及術後7、30 d 測定 N 末耑 B 型腦鈉肽前體（NT-proBNP）及細胞因子超敏C反應蛋白（hs-CRP）、白介素6（IL-6）及細胞間黏附分子-1（ICAM-1）水平。記錄兩組術後30 d內主要心血管事件（再髮心絞痛、再髮急性心肌梗死及心力衰竭髮作）和其他心血管事件（噁性心律失常及猝死）的髮生情況。結果不同藥物對TIMI血流分級、CTFC、收縮壓、舒張壓及心率的影響比較，差異無統計學意義（P﹥0.05）。兩組用藥後10、20 min TIMI血流分級、CTFC與用藥前比較，差異有統計學意義（P﹤0.05）。不同藥物對LVESD、LVEDD、LVEF 的影響比較，差異無統計學意義（ P ﹥0.05）。兩組術後30 d LVESD、LVEDD及LVEF與術前比較，差異有統計學意義（ P﹤0.05）。不同藥物對NT-proBNP、hs-CRP、IL-6及ICAM-1的影響比較，差異無統計學意義（ P﹥0.05）。兩組術後7、30 d NT-proBNP、hs-CRP、IL-6、ICAM-1水平均低于術前，差異有統計學意義（ P﹤0.01）。兩組術後30 d內主要心血管事件及其他心血管事件髮生率比較，差異均無統計學意義（P﹥0.05）。結論地爾硫卓艸和硝普鈉均能夠有效改善 PCI 術中 TIMI 血流分級及 CTFC，降低炎性因子和NT-proBNP水平，改善心功能，兩者改善無複流現象的效果相噹。
목적：비교지이류탁초화초보납재개선급성관맥종합정（ ACS）환자경피관상동맥개입（ PCI）치료중무복류현상적효과。방법선취2008년1월—2014년6월우강서성인민의원접수PCI치료차술중출현무복류현상적ACS환자80례위연구대상，채용수궤수자표법장환자분위지이류탁초조（40례）화초보납조（40례）。량조우PCI술중경미도관관상동맥파병변원단2 s내“탄환식”쾌속분별급여지이류탁초、초보납200~600μg，분별우급약후10、20 min후복사관상동맥조영，평개심기경사용전치료（ TIMI）혈류분급화교정적TIMI혈류정수（ CTFC），동시기록급약전급급약후10、20 min유창혈압급심솔적변화。분별우PCI술전급술후7、30 d기록좌심실수축말내경（ LVESD）、좌심실서장말내경（ LVEDD）급좌심실사혈분수（ LVEF）。우 PCI 술전급술후7、30 d 측정 N 말단 B 형뇌납태전체（NT-proBNP）급세포인자초민C반응단백（hs-CRP）、백개소6（IL-6）급세포간점부분자-1（ICAM-1）수평。기록량조술후30 d내주요심혈관사건（재발심교통、재발급성심기경사급심력쇠갈발작）화기타심혈관사건（악성심률실상급졸사）적발생정황。결과불동약물대TIMI혈류분급、CTFC、수축압、서장압급심솔적영향비교，차이무통계학의의（P﹥0.05）。량조용약후10、20 min TIMI혈류분급、CTFC여용약전비교，차이유통계학의의（P﹤0.05）。불동약물대LVESD、LVEDD、LVEF 적영향비교，차이무통계학의의（ P ﹥0.05）。량조술후30 d LVESD、LVEDD급LVEF여술전비교，차이유통계학의의（ P﹤0.05）。불동약물대NT-proBNP、hs-CRP、IL-6급ICAM-1적영향비교，차이무통계학의의（ P﹥0.05）。량조술후7、30 d NT-proBNP、hs-CRP、IL-6、ICAM-1수평균저우술전，차이유통계학의의（ P﹤0.01）。량조술후30 d내주요심혈관사건급기타심혈관사건발생솔비교，차이균무통계학의의（P﹥0.05）。결론지이류탁초화초보납균능구유효개선 PCI 술중 TIMI 혈류분급급 CTFC，강저염성인자화NT-proBNP수평，개선심공능，량자개선무복류현상적효과상당。
Objective To make a comparison between diltiazem and sodium nitroprusside in alleviating no -flow phenomenon in patients with acute coronary syndrome( ACS)during percutaneous coronary intervention( PCI). Methods We enrolled 80 ACS patients who had no -flow phenomenon during PCI undertaken in Jiangxi Provincial People's Hospital from January 2008 to June 2014. Using random number table method,the patients were divided into two groups:diltiazem group (group A,n=40)and sodium nitroprusside group(group B,n=40). Group A was given diltiazem 200 -600 μg by pellet injection from microcatheter selective coronary to far-end target lesions in two seconds,group B was given sodium nitroprusside 200-600 μg in the same way. Coronary arteriography was retaken 10 minutes and 20 minutes after administration. Thrombolysis in Myocardial Infarction( TIMI)flow grade and corrected TIMI frame count( CTFC)were evaluated. Invasive blood pressure and heart rate were recorded before administration and 10 minutes and 20 minutes after administration. LVESD,LVEDD and LVEF were recorded before PCI and 7 days and 30 days after PCI. The levels of NT-proBNP,hs-CRP,IL-6 and ICAM-1 were recorded before PCI and 7 days and 30 days after PCI. The incidence rates of major cardiovascular events( re-angina,re-myocardial infarction and heart failure)and other cardiovascular events( malignant arrhythmia and sudden death)were recorded. Results The two medicines were not significantly different(P ﹥0. 05)in the influence on TIMI flow grade,CTFC,systolic pressure,diastolic pressure and heart rate. TIMI flow grade and CTFC of the two groups at 10 minutes and 20 minutes after administration were significantly different from those before administration(P﹤0. 05). The two medicines were not significantly different(P﹥0. 05)in the influence on LVESD,LVEDD and LVEF. The levels of LVESD,LVEDD and LVEF of the two groups on 30 days after administration were significantly different from those before administration ( P ﹤ 0. 05 ). The two medicines were not significantly different(P﹥0. 05)in the influence on NT-proBNP,hs-CRP,IL-6 and ICAM-1. The levels of NT-proBNP,hs -CRP,IL -6 and ICAM -1 of the two groups on 7 days and 30 days after administration were significantly different from those before administration(P﹤0. 05). The two groups were not significantly(P﹥0. 05)different in the incidence rates of major cardiovascular events and other cardiovascular events. Conclusion Diltiazem and sodium nitroprusside can effectively improve TIMI flow grade and CTFC,reduce the levels of inflammatory factor and NT-proBNP and improve cardiac function. The two medicines have equally good effect on alleviating on-flow pheonmenon.
