新活素对急性前壁心肌梗死急诊PCI术后对比剂肾病疗效的观察

发布时间：2018-05-19 00:35

本文选题：新活素 + 急性前壁心肌梗死　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：探讨急诊经皮冠脉介入治疗（percutaneous coronaryintervertion，PCI）术前血清N-末端脑钠肽前体（NT-proBNP）水平与急性前壁心梗（acute anterior wall myocardial infarction）患者术后发生对比剂肾病（contrast induced nephropathy，CIN）的相关性；观察术后立即应用冻干重组人脑利钠肽（新活素，rhBNP）持续静脉滴注24小时对肾功能的影响。方法：随机入选60例在辽宁省人民医院心内科同意接受急诊PCI术治疗的急性前壁心肌梗死患者，术前均给予阿司匹林肠溶片300毫克、波立维600毫克常规顿服，非离子型低渗造影剂碘普罗胺(优维显)均在术中应用，血清肌酐(Scr)标准衡量肾功能水平。将60例研究对象随机分为两组：a.对照组（30例）：予以阿司匹林肠溶片、波立维、β受体阻断剂、他汀类药物、血管紧张素受体阻断剂（ARB）或血管紧张素转换酶抑制剂(ACEI)等术后常规治疗；b.新活素组（30例）：除应用上述术后常规药物治疗外，先以90秒匀速静脉注射负荷剂量1．5μg/kg·min，其后24小时以0．0075μg/kg·min的速率匀速静脉泵入；分别了解两组术前血清Scr、NT-proBNP水平，术后24小时、48小时、72小时血清Scr水平。结果：1.随机入选60例急性前壁心肌梗死、同意接受急诊PCI术治疗的患者中，对照组男性18例、女性12例，新活素组男性23例、女性7例，平均年龄为(60.28±13.03)岁，对照组患者的年龄、性别、糖尿病、高血压、高血脂、心力衰竭（LVEF40%）、慢性肾脏病、吸烟、造影剂剂量水平与新活素组相比较均无明显差异（P0.05）；2.两组CIN发生率：对照组CIN8例，发生率为26.67%，，新活素组CIN1例，发生率为3.45%，新活素组CIN发生率比对照组要低，差别具有统计学意义(P0.05)；3.两组术前血清Scr、NT-proBNP水平及术后24小时血清Scr水平均无明显差异性（P㧐0.05），新活素组术后48小时及72小时血清Scr水平比对照组的显著减少，差别具有统计学意义（P0.05）；4.术前血清NT-proBNP水平与CIN的发生成正相关，对照组发生CIN的风险随血清NT-ProBNP水平的增加有增加趋势。结论：急诊PCI术前血清NT-proBNP水平可能是预测出急性前壁心梗患者发生CIN的早期生物标记物之一，且可成为早期筛查CIN人群的手段，提高对CIN的防范意识；新活素可保护肾功能、有效改善或预防急诊PCI术后急性肾功能不全，降低CIN的发生率，其应用为临床防治CIN提供了更多的药物选择。
[Abstract]:Objective: to investigate the correlation between the serum NT-proBNPs before percutaneous coronary intervention (PCI) and the incidence of contrast induced nephropathy (cin) in patients with acute anterior wall infarction (AMI). The effects of freeze-dried recombinant human brain natriuretic peptide (rhBNP) on renal function were observed immediately after operation. Methods: sixty patients with acute anterior myocardial infarction (AMI) who accepted emergency PCI operation in Department of Cardiology, Liaoning Provincial people's Hospital were randomly selected. All patients were given aspirin enteric-coated tablets (300mg) and Polivir (600mg) for routine administration before operation. Non-ionic hypotonic contrast agent iopramide was used during operation and serum creatinine Scrs was used to measure renal function. 60 subjects were randomly divided into two groups: a. The control group (n = 30) was treated with aspirin enteric-coated tablets, Borivir, 尾 -blockers, statins, angiotensin receptor blockers (ARB) or angiotensin converting enzyme inhibitor (ACEI). 30 patients in the neovasin group were treated with the above routine drugs, the loading dose was injected intravenously for 90 seconds at a dose of 1.5 渭 g/kg, and then pumped into the vein at a rate of 0.0075 渭 g/kg min at 24 hours after the operation, and the serum levels of Scrn NT-proBNP in the two groups were determined. The serum Scr level was 24 hours, 48 hours and 72 hours after operation. The result is 1: 1. 60 patients with acute anterior myocardial infarction (AMI) were randomly selected. The control group consisted of 18 males, 12 females, 23 males and 7 females, with an average age of 60.28 卤13.03 years. The age and sex of the patients in the control group were compared with those in the control group (n = 18), female (n = 12), neovasin group (n = 23) and female (n = 7). Diabetes, hypertension, hyperlipidemia, heart failure LVEF40, chronic kidney disease, smoking, contrast agent dose levels compared with the new live hormone group, there was no significant difference (P 0.05). The incidence of CIN in the two groups was 26.67 in the control group and 3.45 in the neovasin group. The incidence of CIN in the neovasin group was lower than that in the control group, and the difference was statistically significant (P 0.05). There was no significant difference in the levels of serum Scrn NT-proBNP and serum Scr 24 hours after operation between the two groups. The serum Scr levels in the neovasin group at 48 hours and 72 hours after operation were significantly lower than those in the control group, and the difference was statistically significant. Preoperative serum NT-proBNP level was positively correlated with the occurrence of CIN, and the risk of CIN in the control group tended to increase with the increase of serum NT-ProBNP level. Conclusion: the serum NT-proBNP level before emergency PCI may be one of the early biomarkers for predicting the occurrence of CIN in patients with acute anterior myocardial infarction, and it can be used as an early method to screen CIN population and raise the awareness of prevention of CIN, while neovasin can protect renal function. It can effectively improve or prevent acute renal insufficiency and reduce the incidence of CIN after emergency PCI, which provides more drug choice for clinical prevention and treatment of CIN.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R542.22

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