论文部分内容阅读
目的:探讨地尔硫对急性冠状动脉综合征(ACS)患者冠状动脉介入治疗(PCI)后的影响。方法:选取入住四川大学华西医院心内科、经冠状动脉造影确诊为ACS,并接受PCI的患者共53例,随机分为地尔硫组和对照组,地尔硫组于PCI后即刻给予地尔硫5μg·kg-1·min-1,持续24h。观察2组心绞痛发作次数,2组术前,术后即刻、24、48、72h血压、心率、心肌氧耗指数变化,以及C反应蛋白(CRP)和氨基末端脑钠肽前体(NT-proBNP)水平。结果:①2组在观察期内心绞痛发作次数差异无统计学意义[地尔硫组(2·6±1·2)次,对照组(2·8±1·5)次]。②2组在术前和术后即刻血压、心率并无显著差异,但术后24h地尔硫组较对照组血压、心率均有明显降低[地尔硫组:血压(122·8±16·6)/(72·5±6·7)mmHg,心率(67·4±8·5)次/min;对照组:血压(135·6±18·9)/(86·2±9·7)mmHg,心率(78·9±10·6)次/min],2组比较差异有统计学意义(均P<0·01),且一直保持到术后72h,地尔硫组可有效降低心肌氧耗指数。③2组在术前和术后即刻CRP、NT-proBNP并无显著差异,但术后较术前CRP、NT-proBNP水平升高[地尔硫组:术前CRP(20·4±4·3)mg/L,NT-proBNP(254·2±31·7)ng/L,术后即刻CRP(39·8±8·6)mg/L,NT-proBNP(448·9±51·2)ng/L;对照组:术前CRP(18·6±5.2)mg/L,NT-proBNP(210.5±29.8)ng/L,术后即刻CRP(41.2±9.1)mg/L,NT-proBNP(502.6±57.4)ng/L]。术后24h地尔硫组较对照组CRP、NT-proBNP均有明显降低[地尔硫组:CRP(25.2±3.2)mg/L,NT-proBNP(202.5±21.4)ng/L;对照组:CRP(39.7±8.5)mg/L,NT-proBNP(482.3±49.7)ng/L,2组比较差异有统计学意义(P<0·05),且一直保持到术后72h。结论:地尔硫可降低ACS患者PCI后的心率、血压和心肌氧耗指数,并可显著降低PCI后CRP和NT-proBNP水平,有可能改善ACS患者PCI的预后。
Objective: To investigate the effect of diltiazem on patients with acute coronary syndrome (ACS) after coronary intervention (PCI). Methods: Fifty-three patients admitted to Department of Cardiology, West China Hospital of Sichuan University, and diagnosed as ACS by coronary angiography were randomly divided into Diltiazem group and control group. Diltiazem group was given immediately after PCI Diltiazem 5μg · kg-1 · min-1 for 24 h. The number of angina pectoris, the changes of blood pressure, heart rate and myocardial oxygen consumption index at 24, 48 and 72 hours before operation and immediately after operation in both groups were observed. The levels of C-reactive protein (CRP) and NT-proBNP )Level. Results: ① There was no significant difference in the number of angina attacks between the two groups during the observation period (2.6 ± 1.2 in diltiazem group, and 2.8 ± 1.5 in control group). ② There was no significant difference in blood pressure and heart rate between the two groups before and immediately after surgery, but the blood pressure and heart rate of diltiazem group after 24 h were significantly lower than those of the control group [Diltiazem group: blood pressure (122.8 ± 16) (72.5 ± 6.7) mmHg and heart rate (67.4 ± 8.5) times / min in the control group, while the control group had no significant difference in the blood pressure (135.6 ± 18.9) / (86.2 ± 9 ·) 7) mmHg, and heart rate (78.9 ± 10.6) times / min. There was significant difference between the two groups (all P <0.01), and remained at 72h after operation. Diltiazem group Effectively reduce myocardial oxygen consumption index. There was no significant difference in CRP and NT-proBNP both before and immediately after operation in group 2, but the levels of CRP and NT-proBNP in the two groups were significantly increased after surgery [Diltiazem group: Preoperative CRP (20.4 ± 4. · (39.8 ± 8.6) mg / L, NT-proBNP (448.9 ± 51.2), postoperative serum levels of NT-proBNP (n = 20). The control group had preoperative CRP (18.6 ± 5.2) mg / L and NT-proBNP (210.5 ± 29.8) ng / L and CRP (41.2 ± 9.1) mg / (502.6 ± 57.4) ng / L]. The levels of CRP and NT-proBNP were significantly lower in diltiazem group at 24 hours after operation compared with those in the control group [diltiazem group: CRP (25.2 ± 3.2) mg / L and NT-proBNP (202.5 ± 21.4) ng / There was significant difference between the two groups (P <0.05), and remained at 72h after operation. The levels of CRP (39.7 ± 8.5) mg / L and NT-proBNP were 482.3 ± 49.7 ng / L. Conclusion: Diltiazem can reduce heart rate, blood pressure and myocardial oxygen consumption index after PCI in patients with ACS, and can significantly reduce the level of CRP and NT-proBNP after PCI, which may improve the prognosis of PCI in patients with ACS.