论文部分内容阅读
目的探讨比伐卢定急诊PCI治疗对出血高危急性ST段抬高型心肌梗死患者心肌梗死面积以及炎性反应水平的影响。方法选择100例有出血高危因素的急性ST段抬高型心肌梗死患者,以信封法随机分为观察组(比伐卢定组)和对照组(肝素组)各50例。观察组急诊PCI术前静脉给予比伐卢定;对照组在急诊PCI术前给予普通肝素。入组患者均于入院后每隔4h抽取静脉血,连续监测72h,采用美国Triage全自动免疫分析仪检测心肌酶学指标,计算机IMAGE软件自动分析心肌酶学曲线下面积作为心肌梗死面积判断标准,术后1个月采用心脏超声检查左室射血分数(EF值)以及左室舒张功能指标(E/A比值),采用免疫化学法检测血浆钠尿肽(BNP)水平。术后第3天,采用免疫比浊法检测并比较2组血清高敏C反应蛋白(hs-CRP)、白介素-6(IL-6)水平变化。结果术后72h,观察组心肌梗死面积为(4387.98±876.27)U·h/L小于对照组的(4906.82±854.18)U·h/L,差异有统计学意义(P<0.05)。术后72h,观察组BNP水平降低,E/A比值增加,差异有统计学意义(P<0.05)。2组EF值比较差异无统计学意义(P>0.05)。术后第3天,观察组血清hs-CRP与IL-6水平较术前均明显降低,且观察组低于对照组,差异有统计学意义(P<0.05)。结论比伐卢定用于急性ST段抬高型心肌梗死患者急诊PCI治疗,可以减轻血管内炎性反应水平,减少心肌梗死面积,提高心脏舒张功能,但对于心脏收缩功能无明显影响。
Objective To investigate the effect of bivalirudin emergency PCI on myocardial infarct size and inflammatory response in patients with acute ST-segment elevation myocardial infarction (MHT) at high risk of hemorrhage. Methods A total of 100 patients with acute ST-segment elevation myocardial infarction who were at risk of bleeding were selected and randomly divided into observation group (bivalirudin group) and control group (heparin group) by envelope method. Patients in the observation group were given intravenous bivalirudin intravenously before PCI; in the control group, unfractionated heparin was given before emergency PCI. Patients were enrolled in the hospital every 4h after the extraction of venous blood, continuous monitoring of 72h, using the United States Triage automatic immunoassay for detecting myocardial enzymes, computer IMAGE software automatically analyze the area under the curve of myocardial enzymes as myocardial infarction area to determine the standard, At 1 month after operation, left ventricular ejection fraction (EF) and left ventricular diastolic function (E / A ratio) were measured by echocardiography, and plasma levels of natriuretic peptide (BNP) were measured by immunochemistry. On the third day after operation, the levels of serum hs-CRP and IL-6 in the two groups were detected and compared by immunoturbidimetry. Results The area of myocardial infarction in observation group was (4387.98 ± 876.27) U · h / L at 72h after operation was lower than that in control group (4906.82 ± 854.18) U · h / L, the difference was statistically significant (P <0.05). At 72h after operation, the level of BNP decreased and the ratio of E / A increased in the observation group. The difference was statistically significant (P <0.05). There was no significant difference in EF between the two groups (P> 0.05). On the third day after operation, the serum levels of hs-CRP and IL-6 in the observation group were significantly lower than those in the control group, and the observation group was lower than the control group (P <0.05). Conclusion Bivalirudin can be used to treat acute ST-segment elevation myocardial infarction in patients undergoing PCI. It can reduce the level of inflammatory reaction, reduce the area of myocardial infarction and improve diastolic function, but has no significant effect on cardiac systolic function.