血塞通注射液对急性ST段抬高型心肌梗死患者PCI术后炎症反应及心功能的影响

发布时间：2018-03-21 07:05

  本文选题：ST段抬高型急性心肌梗死　切入点：炎症反应　出处：《河南中医学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的:观察血塞通注射液对急性ST段抬高型心肌梗死患者PCI术后炎症反应及心功能的影响。方法收集2013年2月-2015年3月入住河南中医学院第一附属医院被确诊为急性ST段抬高型心肌梗死、中医诊断符合血瘀证、急诊行PCI术治疗的患者。共纳入70例,术前随机分为观察组34人,对照组36人。两组患者均按照最新PCI治疗指南常规进行,两组患者术前常规均阿司匹林300mg嚼服,氯吡格雷600mg口服;试验组术前给予血塞通注射液静脉推注400mg,并于术后连续静脉滴注,血塞通400mg+GS/NS250ml,每天1次,连续使用14天;对照组给予等量的安慰剂。对比分析两组患者术前及术后15天的超敏C反应蛋白(Hs CRP)、五聚蛋白3(PTX-3)、脑钠肽(BNP)水平的差异性及术前、术后24h心肌酶(CK-MB)、超敏肌钙蛋白(c Tn T)的水平变化,以及术后即刻和1月后的心脏左室射血分数(LVEF)及左室舒张末内经(LVEDd)的差异性,血瘀证评分的变化情况。结果:1、两组基线的比较两组患者的基线资料包括性别、年龄、高血压病史、糖尿病病史、血脂代谢异常病史、心梗病史、心梗部位、累计病变等均无统计学差异(P0.05)。2、炎症指标的变化两组患者治疗前的血清Hs CRP、PTX-3水平比较,差异无统计学意义(P0.05);治疗后两组患者血清Hs CRP、PTX-3均降低,但对照组治疗前后差异无统计学意义(P0.05)。试验组治疗后比对照组显著降低,差异均有统计学意义[Hs CRP:(2.48±1.76)比(5.12±1.54)mg/L,t=3.264,P=0.024;PTX-3:(4.8±1.3)比(7.2±2.3)ng/ml,t=3.526,P=0.01].3、心肌损伤标记物的变化两组患者术前CK-MB和c Tn T水平的比较,差异无统计学意义(P0.05);术后24h两组患者的CK-MB和c Tn T水平均较前降低,且试验组比对照组降低的更明显,差异有统计学意义[CK-MB:(62.4±12.3)比(142.6±36.4)U/L,t=4.231,P=0.016;c Tn T:(12.5±3.6)比(34.8±7.2)μg/L,t=3.957,P=0.014]。4、BNP评价结果两组患者入院即刻BNP水平比较,差异无统计学意义(P0.05);术后15天两组患者BNP水平均明显下降,且试验组比对照组降低的更明显,差异有统计学意义[(153±122)比(249±191)pg/ml,t=3.426,P=0.026].5、心脏彩超两组患者术后即刻行心脏彩超LVDd及EF水平的比较,差异均无统计学意义(P0.05);术后15天和30天的LVDd水平较前明显降低,EF水平较前明显升高,且随着时间延长,改善更明显,组内比较均有统计学意义(P0.05)。两组患者术后15天的LVDd及EF水平的比较,差异均无统计学意义(P0.05);而术后30天试验组的LVDd水平较对照组更加降低,EF水平更加升高,差异均有统计学意义[LVDd:(53.6±4.8)比(54.7±3.9)mm,t=1.925,P=0.041;EF:(50.3±4.1)比(49.6±3.8)%,t=1.892,P=0.043].6、患者血瘀证评分比较两组患者术前血瘀证评分的比较,差异无统计学意义(P0.05);术后15天两组患者血瘀证评分均明显下降,且试验组比对照组降低的更明显,差异有统计学意义[(28.6±10.1)比(34.1±11.2)分,t=2.856,P=0.039].结论:血塞通注射液能够降低急性ST段抬高型心肌梗死患者的炎症反应,改善患者心功能,降低血瘀证积分。
[Abstract]:Objective: To observe the effect of Xuesaitong Injection on inflammatory response and cardiac function in patients with acute ST segment elevation myocardial infarction patients after PCI. Methods from February 2013 -2015 year in March in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine was diagnosed with acute ST elevation myocardial infarction, TCM diagnosis of blood stasis syndrome, the emergency patients received PCI therapy were included. 70 cases before operation were randomly divided into observation group of 34 people, 36 people in the control group. Two patients were in accordance with the new guidelines for the treatment of conventional PCI, two groups of patients before routine were chewing aspirin 300mg, clopidogrel 600mg oral test group; preoperative Administration of Xuesaitong injection intravenous injection of 400mg, and in operation after continuous intravenous injection, Xuesaitong injection 400mg+GS/NS250ml, 1 times a day, 14 days of continuous use; the control group given placebo. Analysis of high sensitive C reactive protein in 15 days of the two groups of patients before and after contrast (Hs CRP), five poly Protein 3 (PTX-3), brain natriuretic peptide (BNP) and the level of difference operation, postoperative myocardial enzyme 24h (CK-MB), high-sensitivity troponin (C Tn T) level changes, and immediately after operation and in January after the left ventricular ejection fraction (LVEF) and left ventricular end diastolic period the difference (LVEDd), changes of blood stasis score. Results: 1, the two groups at baseline were compared between two groups of baseline data including gender, age, history of hypertension, history of diabetes, history, abnormal lipid metabolism, myocardial infarction, infarct location, total lesions were not statistically significant (P0.05.2). Serum Hs CRP changes of inflammatory index of patients in two groups before treatment, the level of PTX-3, the difference was not statistically significant (P0.05); the two groups after treatment of serum Hs in patients with CRP, PTX-3 decreased, but the control group before and after treatment the difference was not statistically significant (P0.05). The test group after treatment significantly lower than control group, the differences were statistical significance 涔塠Hs CRP:(2.48卤1.76)姣，

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