血栓抽吸对急性ST段抬高心肌梗死患者NT-proBNP水平及左室功能的影响

发布时间：2018-05-07 01:38

本文选题：急性ST抬高心肌梗塞 + 经皮冠状动脉介入治疗　；参考：《桂林医学院》2013年硕士论文

【摘要】：目的：比较血栓抽吸(thrombus aspiration)加常规急诊经皮冠状动脉冠状动脉介入（percutaneous coronary intervensions，PCI）和单纯常规急诊PCI两种方法对急性ST段抬高心肌梗死(STEMI)患者术后血浆氨基末端脑利钠肽前体(N-terminal pro-brainnatriureticpeptide，NT-proBNP)水平及左室功能及预后的影响，以期进一步探讨血栓抽吸改善STMI患者预后的机理，为冠心病的治疗提供有价值的参考依据。方法：入选2009年8月-2012年10月期间在我院住院诊断为STEMI并行急诊PCI的患者80例，随机分为以下2组：(1)单纯介入治疗组（常规PCI组）：40例，(2)血栓抽吸组+支架置入组（血栓抽吸+常规PCI组）:40例。比较：⑴两组术后即刻心肌梗死溶栓治疗(TIMI)血流分级；(2)两组术后即刻、术后48小时、术后3月、术后6月的NT-proBNP水平；（3）术后肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)及超敏C反应蛋白（hs-CRP）的峰值和达峰时间；（4）术后3天和6月心脏功能情况：使用心脏多谱勒超声心动图测量左室舒张末期容积（LVEDV）、左室收缩末期容积(LVESV)、每搏量(SV)、左室射血分数（LVEF)；（5）术后血管不良事件(major adverse cardiovascular events，MACE)的发生情况。结果：1.入院即刻肘静脉血与罪犯冠状动脉血中NT-proBNP（pg/mL）对比:1804.8士951.3vs1911.8士851.3，无统计学差异，P＞0.05。血栓抽吸组与对照组相比，入院即刻NT-proBNP无统计学差异，术后48小时877.6±651.2vs1316.7±799.6，术后3月123.8±64.2vs188.7±82.4，术后6月113.4±44.1vs177.5±79.2，血栓抽吸组均低于对照组，差异有统计学意义，P＜0.05。2.两组患者出现TIMI0-1级例数：在血栓抽吸组1例(2.5%)，而对照组出现8例(20%)。差异有统计学意义(P＜0.05)。出现TIMI2级例数两组相近10%vs17.5%，差异无统计学意义，P＞0.05。出现TIMI3级例数血栓抽吸组明显多于对照组，87.5%vs52.5%,差异有统计学意义，P0.05。3.心脏彩超测量心功能：PCI术后3天血栓抽吸组患者左心功能各参数略好于对照组，但差异无统计学意义，P＞0.05。PCI术后6个月时血栓抽吸组左室舒张末期容积（LVEDV）（84.68±12.95vs98.32±18.49）、每搏量（SV）（52.41±8.18vs46.63±7.18）、左室射血分数（LVEF）（61.25±10.05vs47.15±5.05）较对照组明显改善，，差异有统计学意义，P＜0.05。4.血栓抽吸组与对照组相比，肌酸激酶同工酶（CK-MB）峰值（187.1±64.3vs221.6±56.1）、肌钙蛋白I（cTnI）峰值（28.2±15.9vs41.2±19.3）、超敏C反应蛋白（hs-CRP）峰值（26.4±20.8vs46.4±22.7）均降低，肌酸激酶同工酶（CK-MB）达峰时间提前（9.8±6.5vs13.1±5.5）差异有统计学意义（P0.05)。5.术后6个月观察终点比较（MACE）：血栓抽吸组和对照组相比，有减少趋势，但无统计学差异（P0.05）。结论：1.显示抽吸导管抽合并常规PCI治疗较常规PCI可明显改善TIMI血流分级，减少冠脉“无复流”或“慢血流”。2.抽吸导管抽合并常规PCI治疗较常规PCI可降低NT-proBNP表达。3.抽吸导管抽合并常规PCI治疗较常规PCI可明显改善心肌组织灌注水平，改善左心功能，减少心室重构发生。
[Abstract]:Objective: to compare the effect of thrombus aspiration plus percutaneous coronary intervention (PCI) and percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) after operation of plasma amino-terminal brain natriuretic peptide (ACTNP) in patients with acute ST-segment elevation myocardial infarction (STEMI). The effects of N-terminal N-terminal NT-proBNPs on the left ventricular function and prognosis, NT-proBNPs, NT-proBNPs, and NT-proBNPs. To further explore the mechanism of thrombotic aspiration to improve the prognosis of patients with STMI, and to provide a valuable reference for the treatment of coronary heart disease. Methods: from August 2009 to October 2012, 80 patients with STEMI and emergency PCI were enrolled in our hospital. They were randomly divided into the following two groups: intervention group (routine PCI group, n = 40), thrombus aspiration group (n = 40, n = 40), thrombotic aspiration group (n = 40), thrombotic aspiration group (n = 40), conventional PCI group (n = 40, n = 40). Comparison of immediate thrombolytic therapy of myocardial infarction with thrombolytic therapy in two groups (TIMI2): immediately after operation, 48 hours after operation, and 3 months after operation, the two groups were treated with thrombolytic therapy. The peak value of creatine kinase isoenzyme (CK-MBN), cardiac troponin I (cTnI) and hypersensitive C-reactive protein hs-CRP (hs-CRP) in 6 months after operation were measured by echocardiography 3 days and 6 months after operation. Left ventricular end-diastolic volume (LVEDVV), left ventricular end-systolic volume (LVESVV), left ventricular ejection fraction (LVEF) and left ventricular ejection fraction (LVEF). The result is 1: 1. There was no significant difference in NT-proBNPP PG / mL between NT-proBNPpg / mL (1808 + 951.3vs1911.8 = 851.3, P > 0.05) immediately after admission, and no significant difference was found between the two groups (P > 0.05). There was no significant difference in NT-proBNP between the thrombotic aspiration group and the control group. At 48 hours after operation, 877.6 卤651.2vs1316.7 卤799.6, 123.8 卤64.2vs188.7 卤82.4 at 3 months after operation and 113.4 卤44.1vs177.5 卤79.2 at 6 months after operation, the NT-proBNP in the thrombotic aspiration group was lower than that in the control group (P < 0.05.2). The number of TIMI0-1 grade cases in the two groups: one case in the thrombotic aspiration group and one case in the thrombotic aspiration group, and 8 cases in the control group. The difference was statistically significant (P < 0.05). The number of TIMI2 cases in the two groups was similar to 10 vs 17. 5, the difference was not statistically significant (P > 0. 05). The number of TIMI3 patients in the thrombotic aspiration group was significantly higher than that in the control group (87.5 vs 52.5), and the difference was statistically significant (P 0.05.3). The parameters of left ventricular function in the thrombotic aspiration group were slightly better than those in the control group 3 days after PCI by color Doppler echocardiography. However, there was no significant difference in left ventricular end-diastolic volume (LVEDVV), 52.41 卤8.18vs46.63 卤7.18g / L, 61.25 卤10.05vs47.15 卤5.05 left ventricular ejection fraction (LVEF) in the thrombotic aspiration group at 6 months after 0.05.PCI (P < 0.05.4), but there was no significant difference in the left ventricular end-diastolic volume (LVEVV), 52.41 卤8.18vs46.63 卤7.18g / L and 61.25 卤10.05vs47.15 卤5.05 (P < 0.05.4) in the thrombotic aspiration group (P > 0.05), which was significantly higher than that in the control group (P < 0.05). Compared with the control group, the peak value of creatine kinase isoenzyme CK-MBs was 187.1 卤64.3vs221.6 卤56.1g, the peak value of troponin I cTnI was 28.2 卤15.9vs41.2 卤19.3g, and the peak value of hs-CRPs was 26.4 卤22.7. the peak time of creatine kinase isoenzyme CK-MBwas increased by 9.8 卤6.5vs13.1 卤5.5. there was significant difference in the peak time of creatine kinase isoenzyme (CK-MBB). At 6 months after operation, the end points were observed and compared: compared with the control group, the thrombotic aspiration group had a decreasing trend, but there was no statistical difference (P 0.05). Conclusion 1. The results showed that aspiration catheter combined with conventional PCI therapy could significantly improve the grading of TIMI blood flow and reduce coronary "no reflow" or "slow blood flow" .2compared with routine PCI. Aspiration catheter aspiration combined with conventional PCI therapy can reduce the expression of NT-proBNP. 3. 3. Compared with routine PCI, aspiration catheter drainage combined with conventional PCI can significantly improve myocardial perfusion, improve left ventricular function and reduce ventricular remodeling.
【学位授予单位】：桂林医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R542.22

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