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新活素对急性心肌梗死PCI术后患者心肌形变能力、<br />血浆NT-proBNP的影响及安全性分析

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摘要:

目的 探讨新活素对急性心肌梗死行经皮冠状动脉介入治疗(PCI)后患者心肌形变能力、
血浆N-末端脑钠肽前体(NT-proBNP)的影响及安全性。方法 选取2018年5月1日至2020年11月30日于
芜湖市第一人民医院行PCI的86例急性心肌梗死患者,按照随机数字表法分为对照组(予以单硝酸异山
梨酯注射液治疗)与观察组(予以新活素治疗),各43例,对照组于术后1 h内予以单硝酸异山梨酯注射
液治疗,25 mg+0.9%氯化钠注射液250 ml,静脉滴注,1/d。观察组于术后1 h内予以注射用重组人脑利钠
肽治疗,予以1.5 μg/kg静脉推注,随后以0.0075 μg/(kg·min)的速度对患者持续泵入。疗程为3 d。对
比术前、术后即刻、术后1个月的NT-proBNP、C-反应蛋白(CRP)、左室室壁运动指数(LVWMSI)、
舒张晚期峰值应变率(SRa)、舒张早期峰值应变率(SRe)、收缩期峰值应变率(SRs)、左室射血分
数(LVEF)、左室收缩末期容积指数(LVESVI)、左心室舒张末期容积指数(LVEDVI)。观察不良反
应情况,包括低血压、一过性血肌酐升高、高氮血症等,以及出院3个月内的心脏事件发生率,包括心
力衰竭、恶性心律失常、心肌再梗死、心源性死亡等。结果 两组在性别、年龄、发病至就诊时间、心
功能分级、糖尿病史、高血压史、高脂血症史等一般资料比较,差异无统计学意义(P>0.05);术前、
术后即刻,两组LVWMSI、SRa、SRe、SRs、LVEF、LVESVI、LVEDV、NT-proBNP、CRP比较,差异无
统计学意义(P>0.05);术后1个月,观察组的LVWMSI、LVEDVI、NT-proBNP、CRP低于对照组,而
SRa、SRe、SRs、LVEF、LVESVI高于对照组(P<0.05)。观察组不良反应总发生率与对照组相比,差
异无统计学意义(P>0.05)。观察组心力衰竭、恶性心律失常各出现1例,而对照组心力衰竭出现3例、
恶性心律失常、心肌再梗死及心源性死亡各出现2例,观察组心脏事件总发生率4.65%低于对照组心脏事
件总发生率20.93%(P<0.05)。结论 新活素用于急性心肌梗死PCI后患者中有利于改善心肌形变能力
和降低NT-proBNP表达量,且安全性高。

Abstract:

Objective To investigate the effects and safety of Lyophilized Recombinant Human Brain
Natriuretic Peptide on cardiac deformability, plasma NT-proBNP in patients with acute myocardial infarction
undergoing PCI. Methods 86 patients with acute myocardial infarction who underwent PCI in the first people's
Hospital of Wuhu from May 1, 2018, to November 30, 2020, were selected. They were divided into the control
group (treated with Isosorbide Mononitrate Injection, n=43) and the observation group (treated with Lyophilized
Recombinant Human Brain Natriuretic Peptide, n=43). The control group was treated with Isosorbide Mononitrate
Injection, 20 mg + 0.9% sodium chloride injection 250 ml, intravenously, one time/day within one h after operation.
The observation group was treated with Lyophilized Recombinant Human Brain Natriuretic Peptide by injection
within one h after surgery, followed by a 1.5 μg/kg IV bolus followed by 0.0075 μg/ (kg·min) with the belly
continuously pumped to the patient. Treatment duration was 3 d. N-terminal pro-brain natriuretic peptide (NTproBNP),
C-reactive protein (CRP), left ventricular wall motion index (LVWMSI), late diastolic peak strain rate
(SRA), early diastolic peak strain rate (SRE), peak systolic strain rates (SRS), left ventricular ejection fraction (LVEF),
left ventricular end-systolic volume index (LVESVI), and left ventricular end-diastolic volume index (LVEDVI)
were compared before, immediately after, and one month after surgery. Adverse events were observed, including
hypotension, transient serum creatinine elevation, hyperazotemia, and cardiac event rates within three months of
discharge, including heart failure, malignant arrhythmia, reinfarction, and cardiac death. Results There were no significant differences between the two groups in the general data such as gender, age, onset to door time, cardiac
function grade, diabetes mellitus history, hypertension history, hyperlipidemia history (P>0.05); There were no
significant differences in lvwmsi, SRA, SRE, SRS, LVEF, LVESVI, LVEDV, NT proBNP and CRP between the two
groups before operation and immediately after operation (P>0.05); At one month after surgery, lvwmsi, LVEDVI,
NT-proBNP, and CRP were lower in the observation group than in the control group, whereas SRA, SRE, SRS,
LVEF, and LVESVI were higher (P<0.05). There was no significant difference in the overall incidence of adverse
effects in the observation group compared with the control group (P>0.05). One case of heart failure and malignant
arrhythmia occurred in the observation group. In contrast, three cases each of heart failure and two cases each of
malignant arrhythmia, reinfarction, and cardiac death occurred in the control group, and the overall cardiac event
rate of 4.65% in the observation group was lower than the overall cardiac event rate of 20.93% in the control group
(P<0.05). Conclusion The use of Lyophilized Recombinant Human Brain Natriuretic Peptide in patients with acute
myocardial infarction after PCI is beneficial to improve myocardial deformability and reduce the expression of NTproBNP,
and has high safety.

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参考文献:

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