丹参多酚酸盐对急性心肌梗死患者缺血—再灌注损伤的影响

发布时间：2018-02-07 13:05

本文关键词： 丹参多酚酸盐急性ST段抬高型心肌梗死缺血-再灌注损伤校正的TIMI帧数 R波 ST段　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过对急性心肌梗死患者急诊PCI术前应用丹参多酚酸盐,计数梗死相关动脉开通后校正的TIMI帧数评估冠状动脉血流,计量梗死相关动脉开通前后心电图相关导联ST段及R波振幅的变化值评估对心肌缺血-再灌注损伤的影响,探讨急性心肌梗死患者缺血-再灌注损伤的药物治疗方法。方法:选取2016年1月至2016年12月我院心血管内科确诊为急性ST段抬高型心肌梗死患者80例,且发病时间短于12小时,随机分为试验组及对照组,所有入组患者均于术前嚼服拜阿司匹林300mg、替格瑞洛180mg,试验组在常规口服药物基础上加用丹参多酚酸盐200mg静点。分别于梗死相关动脉球囊开通即刻、开通后5分钟、开通后10分钟计数冠状动脉血流充盈至远段分支的校正的TIMI帧数,分别于梗死相关动脉球囊开通前5分钟、开通后即刻、开通后5分钟、开通后10分钟计量心电图相关导联ST段及R波振幅的变化值,对每组患者组内及两组患者之间不同时段上述监测指标进行统计学分析,比较其差异。结果:1两组病例基线指标,即年龄、梗死相关动脉开通前5分钟ST段抬高值、R波振幅及梗死相关动脉开通后即刻校正的TIMI帧数无统计学差异(P0.05)。2对照组梗死相关动脉开通后即刻、5分钟、10分钟时ST段抬高值分别为(0.3580±0.06354)mv、(0.3343±0.06827)mv、(0.3320±0.06888)mv,R波振幅分别为(1.4353±0.20666)mv、(1.4010±0.19525)mv、(1.3720±0.18582)mv,均无统计学意义(P0.05)。梗死相关动脉开通后5分钟、10分钟校正的TIMI帧数分别为(30.2625±5.62844)帧、(29.5500±5.79434)帧,提示梗死相关动脉开通后5分钟、10分钟与基线比较均有统计学意义(P0.05),但梗死相关动脉开通后5分钟与开通后10分钟相比无统计学意义(P0.05)。3试验组梗死相关动脉开通后即刻、5分钟、10分钟时ST段抬高值分别为(0.3522±0.06233)mv、(0.3203±0.06538)mv、(0.2695±0.07531)mv,提示开通后即刻与基线相比无统计学意义(P0.05),开通后5分钟、10分钟与基线及开通后即刻相比均有统计学意义(P0.05),开通后10分钟与开通后5分钟相比仍有统计学意义(P0.05)。R波振幅分别为(1.3875±0.18403)mv、(1.3838±0.18422)mv、(1.3810±0.18282)mv,均无统计学意义(P0.05)。梗死相关动脉开通后5分钟、10分钟校正的TIMI帧数分别为(27.1125±4.72512)帧、(24.4125±5.00242)帧,提示开通后5分钟、10分钟与基线比较均有统计学意义(P0.05),开通后5分钟与开通后10分钟相比仍有统计学意义(P0.05)。4组间对比,对照组与实验组ST段抬高值在梗死相关动脉开通后10分钟对比有统计学意义(P0.05),其它时间段对比无统计学意义(P0.05),R波振幅组间不同时间段对比均无统计学意义(P0.05),校正的TIMI帧数在开通后5分钟、10分钟对比均有统计学意义(P0.05)。结论:1丹参多酚酸盐可有效抑制心肌缺血-再灌注损伤,起效时间早,且随时间延长获益增加。2丹参多酚酸盐可改善冠状动脉微循环灌注。
[Abstract]:Objective: to count the corrected TIMI frame number of infarct related artery to evaluate coronary artery flow by using salvia miltiorrhiza polyphenolic acid before emergency PCI in patients with acute myocardial infarction. The effects of St segment and R wave amplitude on myocardial ischemia-reperfusion injury were measured before and after the opening of infarct related artery. Methods: from January 2016 to December 2016, 80 patients with acute ST-segment elevation myocardial infarction were diagnosed as acute ST-segment elevation myocardial infarction, and the onset time was less than 12 hours. They were randomly divided into the experimental group and the control group. All the patients in the study group were chewed with Aspirin 300 mg and tigrilol 180 mg before the operation. The experimental group was treated with salvia miltiorrhiza (200mg) on the basis of routine oral medication, respectively, immediately after the balloon of infarct related artery was opened. The corrected TIMI frames of coronary artery filling to the distal branch were counted 5 minutes before the opening of the infarct-related artery balloon, immediately after the opening, 5 minutes after the opening, 10 minutes after the opening of the coronary artery, 10 minutes after the opening of the coronary artery, and 10 minutes after the opening of the coronary artery. The changes of St segment and R wave amplitude of ECG were measured 10 minutes after the operation. The above monitoring indexes in each group and between the two groups were statistically analyzed and the differences were compared. Results the baseline indexes of the two groups were compared. That is, age, There was no significant difference in the amplitude of St segment elevation and the corrected number of TIMI frames immediately after the opening of infarct-associated artery 5 minutes before the opening of infarct-related artery. There was no significant difference between the control group and the control group. In the control group, St segment lifting was 5 minutes and 10 minutes immediately after the opening of the infarct-related artery. The R wave amplitudes of 0.3320 卤0.06888 mvnvn were 1.4010 卤0.19525 卤0.19525mvn, 1.3720 卤0.18582mv.There was no significant difference between the two groups. The corrected TIMI frame number within 10 minutes after the opening of infarct related artery was 2630.25 卤5.6284444) frame, respectively, and 29.5500 卤5.79434) frames were corrected for 10 minutes after the opening of infarct related artery, and the values of RV wave were 0.3580 卤0.06354mVV, 0.3343 卤0.06827mVN 0.3320 卤0.06828444.The amplitudes of R wave were 1.4010 卤0.19525mvn 卤1.3720 卤0.18582mv.There was no significant difference in the number of TIMI frames corrected for 10 minutes after the opening of infarct related artery. The results indicated that there was significant difference between the baseline and the infarction related artery at 5 minutes and 10 minutes after the opening, but there was no significant difference between the experimental group and the experimental group in 5 minutes after the opening of the infarct related artery and 10 minutes after the opening of the infarct related artery. 3 in the trial group, there was no significant difference in the opening of the infarct related artery. The ST-segment elevation values were 0.3522 卤0.06233mvl 0.3203 卤0.06538mvl 0.2695 卤0.07531mv at 5 minutes and 10 minutes after opening respectively, indicating that there was no significant difference between immediately after opening and baseline (P 0.05), 10 minutes after opening compared with baseline and immediately after opening, there was statistical significance (P 0.05), and 10 minutes after opening had statistical significance compared with baseline and immediately after opening. The amplitudes of P0.05U, R wave were 1.3875 卤0.18403mvlv, 1.3838 卤0.18422mvmv1. 3810 卤0.18282mv, respectively. The corrected TIMI frames were 27.1125 卤4.72512) frames and 24.4125 卤5.00242frames, respectively, 5 minutes after the operation of infarct-related artery, and there was no significant difference in P0.05mv between 5 minutes and 5 minutes after the operation of the infarct-related artery, the amplitude of R wave was 1.3875 卤0.18403mvlv, respectively, and there was no significant difference between the two groups. The corrected TIMI frames were 27.1125 卤4.72512) frames. It was suggested that there was significant difference between the baseline and the baseline at 5 minutes after the opening, and there was still a significant difference between the five minutes after the opening and the 10 minutes after the opening of the operation compared with the baseline, and there was still a significant difference between the two groups, and there was no significant difference between the two groups. ST-segment elevation in the control group and the experimental group was statistically significant 10 minutes after the opening of the infarct-related artery, but no statistical significance was found in the other time periods. There was no statistical significance in the comparison of the amplitude of the R wave in the control group and the experimental group in different time periods, and there was no significant difference in the correlation between the two groups. There were significant differences in the number of TIMI frames at 5 minutes and 10 minutes after opening. Conclusion: 1 Salvia miltiorrhiza polyphenolic acid can effectively inhibit myocardial ischemia-reperfusion injury. The effect time was early and the gain increased with the increase of time. 2 Salvia miltiorrhiza polyphenolic acid could improve coronary microcirculation perfusion.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22

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