重组人脑利钠肽（心活素）对急性前壁心肌梗死患者急诊介入术后近期预后影响的临床试验
发布时间：2018-11-05 08:54
【摘要】：目的：验证重组人脑利钠肽（新活素）对急性前壁心肌梗死患者急诊介入术后近期预后的影响。 方法：选取2012年3月至2013年3月就诊于辽宁省人民医院的30例因急性前壁心肌梗死Killip I-III级，行急诊介入术的患者。随机将患者分为重组人脑利钠肽（新活素）组共18例，此为治疗组，余12例为对照组。两组患者在突发急性前壁心肌梗死后，均予急诊冠脉介入术。术前记录患者血压、实验室指标、18导联心电图，予治疗组依体重负荷量新活素静推。再经桡动脉或股动脉穿刺后行冠脉介入术。术后常规予低分子肝素、抗凝药等药物治疗，，必要时予替罗非班、β-受体阻滞剂、利尿剂、地高辛、西地兰等维持治疗。治疗过程中酌情加入洋地黄、多巴胺、多巴酚丁胺或米力农等正性肌力药，治疗组在常规药物基础上依照体重计算出新活素用量静脉匀速泵入并维持72小时。此次新活素为深圳康哲药业公司生产。分别记录两组介入术后生命体征、胸痛缓解程度、生化指标、心脏彩超的变化。记录术后24小时尿量，记录治疗后1周SV、LAD、左室短轴缩短率、 LVD及LVEF,于入院即刻及治疗后第七天，分别测得BNP值，记录患者1月内发生的心脏不良事件，采用spass17.0软件进行统计学分析。 结果：1.rh-BNP组和对照组患者胸痛均有不同程度的缓解，差异没有统计学意义（P0.05）。 2. rh-BNP组和对照组患者收缩压和舒张压均有下降，但差异没有统计学意义（P0.05）。 3. rh-BNP组和对照组患者心率改变不明显。 4.rh-BNP组患者24小时尿量较对照组患者24小时尿量稍多，但差异无统计学意义(P0.05)。 5. rh-BNP组患者的CK-MB峰值和TNT峰值较对照组低，但差异无统计学意义(P0.05)，BNP变化rh-BNP组和对照组无统计学意义(P0.05)。 6.rh-BNP组和对照组患者的血清Scr变化无统计学意义(P0.05)。 7.rh-BNP组和对照组患者SV、左室短轴缩短率及LVEF,LA均无统计学差异(P0.05)，LVD rh-BNP组和对照组具有统计学意义(P0.05)。 8.rh-BNP组发生不良事件低血钾1例对照组发生不良事件患者死亡1例无统计学意义(P0.05)。 结论：1.rh-BNP可能有早期抑制心肌重塑的作用。 2.rh-BNP对患者肾功能血清Scr未见升高，有一定的安全性。
[Abstract]:Aim: to investigate the effect of recombinant human brain natriuretic peptide (NPP) on the short-term prognosis of patients with acute anterior myocardial infarction (AMI) after emergency intervention. Methods: from March 2012 to March 2013, 30 patients with acute anterior myocardial infarction (Killip I-III) received emergency interventional surgery in Liaoning Provincial people's Hospital. The patients were randomly divided into recombinant human brain natriuretic peptide (neo) group (n = 18), treatment group (n = 12) and control group (n = 12). Patients in both groups were treated with emergency coronary intervention after acute anterior myocardial infarction. Blood pressure, laboratory indexes and 18 lead electrocardiogram were recorded before operation. Coronary intervention was performed after transradial or femoral artery puncture. Low molecular weight heparin (LMWH), anticoagulant and so on, and tirofiban, 尾-receptor blocker, diuretic, digoxin, cilandipine, etc. Positive muscle drugs such as digitalis, dopamine, dobutamine or milrinone were added into the treatment process as appropriate. In the treatment group, the dosage of neovasin was uniformly pumped into the vein according to body weight for 72 hours. The new vitality for Shenzhen Kang Zhe Pharmaceutical Co., Ltd. Vital signs, degree of relief of chest pain, biochemical indexes and changes of color Doppler echocardiography were recorded in the two groups. 24 hours urine volume was recorded, left ventricular shortening rate of SV,LAD, was recorded 1 week after treatment, BNP values were measured by LVD and LVEF, at admission and 7 days after treatment, and adverse cardiac events occurred within 1 month were recorded. Spass17.0 software was used for statistical analysis. Results: the chest pain in 1.rh-BNP group and control group were relieved to different degrees, the difference was not statistically significant (P0.05). 2. Systolic blood pressure and diastolic blood pressure were decreased in rh-BNP group and control group, but the difference was not statistically significant (P0.05). 3. There was no significant change in heart rate in rh-BNP group and control group. The 24 hour urine volume in 4.rh-BNP group was slightly higher than that in control group, but there was no significant difference (P0.05). 5. The peak value of CK-MB and TNT in rh-BNP group was lower than that in control group, but the difference was not statistically significant (P0.05). There was no significant difference between rh-BNP group and control group (P0.05). The changes of serum Scr in 6.rh-BNP group and control group were not statistically significant (P0.05). There was no significant difference in left ventricular shortening rate and LVEF,LA between 7.rh-BNP group and control group (P0.05 in), LVD rh-BNP group and control group (P0.05). There was no significant difference in adverse events and hypokalemia in 8.rh-BNP group (P0.05). Conclusion: 1.rh-BNP may have an early inhibitory effect on myocardial remodeling. 2.rh-BNP has no increase in serum Scr in patients with renal function and is safe to some extent.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R542.22
本文编号：2311569
[Abstract]:Aim: to investigate the effect of recombinant human brain natriuretic peptide (NPP) on the short-term prognosis of patients with acute anterior myocardial infarction (AMI) after emergency intervention. Methods: from March 2012 to March 2013, 30 patients with acute anterior myocardial infarction (Killip I-III) received emergency interventional surgery in Liaoning Provincial people's Hospital. The patients were randomly divided into recombinant human brain natriuretic peptide (neo) group (n = 18), treatment group (n = 12) and control group (n = 12). Patients in both groups were treated with emergency coronary intervention after acute anterior myocardial infarction. Blood pressure, laboratory indexes and 18 lead electrocardiogram were recorded before operation. Coronary intervention was performed after transradial or femoral artery puncture. Low molecular weight heparin (LMWH), anticoagulant and so on, and tirofiban, 尾-receptor blocker, diuretic, digoxin, cilandipine, etc. Positive muscle drugs such as digitalis, dopamine, dobutamine or milrinone were added into the treatment process as appropriate. In the treatment group, the dosage of neovasin was uniformly pumped into the vein according to body weight for 72 hours. The new vitality for Shenzhen Kang Zhe Pharmaceutical Co., Ltd. Vital signs, degree of relief of chest pain, biochemical indexes and changes of color Doppler echocardiography were recorded in the two groups. 24 hours urine volume was recorded, left ventricular shortening rate of SV,LAD, was recorded 1 week after treatment, BNP values were measured by LVD and LVEF, at admission and 7 days after treatment, and adverse cardiac events occurred within 1 month were recorded. Spass17.0 software was used for statistical analysis. Results: the chest pain in 1.rh-BNP group and control group were relieved to different degrees, the difference was not statistically significant (P0.05). 2. Systolic blood pressure and diastolic blood pressure were decreased in rh-BNP group and control group, but the difference was not statistically significant (P0.05). 3. There was no significant change in heart rate in rh-BNP group and control group. The 24 hour urine volume in 4.rh-BNP group was slightly higher than that in control group, but there was no significant difference (P0.05). 5. The peak value of CK-MB and TNT in rh-BNP group was lower than that in control group, but the difference was not statistically significant (P0.05). There was no significant difference between rh-BNP group and control group (P0.05). The changes of serum Scr in 6.rh-BNP group and control group were not statistically significant (P0.05). There was no significant difference in left ventricular shortening rate and LVEF,LA between 7.rh-BNP group and control group (P0.05 in), LVD rh-BNP group and control group (P0.05). There was no significant difference in adverse events and hypokalemia in 8.rh-BNP group (P0.05). Conclusion: 1.rh-BNP may have an early inhibitory effect on myocardial remodeling. 2.rh-BNP has no increase in serum Scr in patients with renal function and is safe to some extent.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R542.22
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