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目的探讨通心络胶囊对急性心肌梗死(acute myocardial infarction,AMI)患者延迟经皮冠状动脉介入治疗(PCI)术后血小板活化因子、血管内皮功能、心肌梗死溶栓治疗(TIMI)血流分级及心功能的影响。方法80例均为江西省人民医院心内科2008年1月—2013年9月收治的AMI住院患者,符合纳入标准,按随机数字表分为通心络胶囊治疗组(简称通心络组,40例)和常规治疗组(简称常规组,40例),治疗1周后行PCI,分别检测CD62P、CD63和GPⅡb/Ⅲa、ET-1、NO及血浆vWF水平,PCI术中测定冠脉内TIMI血流速度、校正的血流帧数(CTFC),同时记录PCI术前、后的无创血压和心率变化及心功能,并与健康对照组(本院门诊体检人员,40名)比较。结果与健康对照组比较,AMI患者血小板活化指标CD62p、CD63及GPⅡb/Ⅲa受体复合物、vWF因子及ET-1显著升高(P<0.01),NO显著降低(P<0.05)。通心络治疗1周后,CD62p、CD63、GPⅡb/Ⅲa及vWF因子、ET-1及NO均较治疗前显著下降(P<0.05,P<0.01);且优于常规组(P<0.05,P<0.01),NO水平明显增加(P<0.01);术后30天上述指标较术后1周改善更明显(P<0.05,P<0.01)。两组患者PCI术后TIMI血流分级和CTFC均有明显提高,通心络组较常规组血流恢复更好,TIMI血流3级获得率更高,差异有统计学意义(P<0.05)。两组PCI术后左室射血分数(LVEF)均明显提高(P<0.01),通心络治疗组改善亦优于常规组(P<0.05);常规组30天后再发心绞痛6例,室速/室颤3例,心力衰竭6例,心源性猝死1例,总心血管事件发生率40%(16/40);通心络组再发心绞痛2例,室速/室颤2例,心力衰竭2例,无心源性猝死的发生,总心血管事件发生率15%(6/40)。两组心血管事件发生率比较,差异有统计学意义(χ2=2.27,P<0.05)。结论通心络胶囊可预防AMI患者延迟PCI术后冠脉内血栓形成及减轻血管内皮损伤,并可改善TIMI血流、加强心脏收缩功能。
Objective To investigate the effects of Tongxinluo capsule on the blood flow classification of patients with acute myocardial infarction (AMI) after delayed percutaneous coronary intervention (PCI), the changes of platelet activating factor, vascular endothelial function, thrombolytic therapy of myocardial infarction (TIMI) Impact of heart function. Methods Eighty patients were all inpatients with AMI who were admitted to Department of Cardiology, Jiangxi Provincial People’s Hospital from January 2008 to September 2013, and were eligible for inclusion. According to the random number table, they were divided into two groups: Tongxinluo capsule group (Control group) and conventional therapy group (40 cases for short) were enrolled in this study. PCI was performed one week after treatment. The levels of CD62P, CD63, GPⅡb / Ⅲa, ET-1, NO and plasma vWF were measured. Intracoronary TIMI flow Speed and corrected CTFC. At the same time, noninvasive blood pressure and heart rate changes and cardiac function before and after PCI were recorded, and compared with healthy control group (40 outpatients in our hospital). Results Compared with the healthy control group, the platelet activation indexes CD62p, CD63 and GPⅡb / Ⅲa receptor complex, vWF factor and ET-1 in AMI patients were significantly increased (P <0.01) and NO significantly decreased (P <0.05). After one week of Tongxinluo treatment, the levels of CD62p, CD63, GPⅡb / Ⅲa and vWF, ET-1 and NO were significantly lower than those before treatment (P0.05, P0.01) (P <0.01). The level of NO was significantly increased (P <0.01). The level of NO was significantly improved 30 days after operation (P <0.05, P <0.01). TIMI flow grade and CTFC were significantly increased in both groups after PCI. Tongxinluo group was better than conventional group in blood flow recovery, TIMI grade 3 blood flow rate was higher, the difference was statistically significant (P <0.05) . The left ventricular ejection fraction (LVEF) in both groups were significantly increased after PCI (P <0.01), and the improvement in Tongxinluo group was also better than that in the conventional group (P <0.05) Speed / ventricular fibrillation in 3 cases, heart failure in 6 cases, sudden cardiac death in 1 case, the total cardiovascular event rate was 40% (16/40); Tongxinluo group recurrence of angina in 2 cases, ventricular tachycardia / ventricular fibrillation in 2 cases , 2 cases of heart failure, no sudden cardiac death, the total incidence of cardiovascular events was 15% (6/40). The incidence of cardiovascular events between the two groups, the difference was statistically significant (χ2 = 2.27, P <0.05). Conclusion Tongxinluo Capsule can prevent AMI patients from post-PCI coronary artery thrombosis and reduce vascular endothelial injury, and can improve TIMI blood flow and enhance cardiac contractility.