N-乙酰半胱氨酸对急性心肌梗死再灌注心律失常的防治效果及作用机制研究

目的探讨N-乙酰半胱氨酸对急性心肌梗死再灌注心律失常的防治效果及作用机制。方法选取我院2008年4月～2011年7月收治的急性心肌梗死患者92例,随机分为两组,经皮冠状动脉介入术治疗后,采用常规治疗患者46例为对照组,在对照组治疗基础上联合N-乙酰半胱氨酸治疗患者46例为观察组,比较两组患者再灌注3 d内发生心律失常情况和临床指标变化情况（血清超氧化物歧化酶活性、肌酸激酶、肌酸激酶同工酶、肌钙蛋白Ⅰ）。结果观察组心律失常发生率（45.7%）明显低于对照组（73.9%）,观察组血清超氧化物歧化酶活性明显高于对照组,观察组肌酸激酶、肌酸激酶同工酶、肌钙蛋白Ⅰ明显均低于对照组,差异均有统计学意义（P〈0.05）。观察组不良反应发生率（28.3%）略高于对照组（15.2%）,差异无统计学意义（P〉0.05）。结论 N-乙酰半胱氨酸对急性心肌梗死再灌注心律失常具有良好的防治效果,可以明显减少心肌损伤的发生,其作用机制主要是通过抗氧化反应来减少心律失常的发生,是一种安全有效的预防手段,值得临床推广使用。

Control effect and mechanism research on reperfusion arrhythmias of patients with acute myocardial infarction by N-acetylcysteine

Objective To investigate the control effect and mechanism on reperfusion arrhythmias of patients with acute myocardial infarction by N-acetylcysteine.Methods 92 patients with acute myocardial infarction were selected in the hospital from April 2008 to July 2011,who were randomly divided into two groups.After percutaneous coronary intervention treatment,46 patients used conventional treatment as the control group.Based on the treatment of the control group,46 patients used N-acetylcysteine treatment as the observation group.The rhythm arrhythmias and clinical indexes(serum superoxide dismutase activity,creatine kinase,creatine kinase isoenzyme,troponin Ⅰ) of patients between two groups were compared after reperfusion for 3 days.Results The incidence of cardiac arrhythmias in the observation group(45.7%) was significantly lower than that in the control group(73.9%).The serum superoxide dismutase activity in the observation group was higher than that in the control group.The creatine kinase,creatine kinase isoenzyme,troponin Ⅰ in the observation group were significantly lower than those in the control group.The differences were statistically significant(P < 0.05).The incidence of adverse reactions in the observation group(28.3%) was higher than that in the control group(15.2%),while the difference was not statistically significant(P > 0.05).Conclusion N-acetylcysteine on reperfusion arrhythmias in patients with acute myocardial infarction has a good effect,which can reduce the myocardial injury.The mechanism of action is mainly through the antioxidant response to reduce arrhythmia and implementation.That is a safe and effective means of prevention and worthy of clinical use.