丹参多酚酸盐对急性心肌梗死患者介入治疗术后心肌组织灌注影响的临床研究

目的 急性心肌梗死患者直接经皮冠状动脉介入治疗(PCI)加丹参多酚酸盐与直接PCI术加常规药物治疗对照相比,是否可以减少无再流,改善心肌微循环,是否可以改善术后6个月的心室重构以及临床终点的影响.方法 随机、平行对照、前瞻性临床研究,入选因首次急性ST段抬高型心肌梗死入院,适合并同意行直接PCI术的患者60例,随机分成2组,直接PCI术+丹参多酚酸盐组30例(A组),直接PCI术+常规药物治疗组30例(B组),随访至术后6个月.采用ST段抬高总和回落百分比(sum STR)、校正的TIMI帧数计数(CTFC)、心肌声学造影检查(MCE)等多种方法评价心肌灌注.观察住院及随访期间患者出血事件、心功能以及心血管事件的发生.结果 2组基础临床情况、急诊CAG结果及急诊PCI置入支架情况差异均无统计学意义(P均>0.05).A组与B组相比,术后TIMI 3级血流发生率高(90.0%与63.3%,χ~2= 4.565,P=0.0326);A组术后1 h心电图平均sum STR≥70%明显高于B组(80.0%与50.0%,χ~2=4.689, P=0.0304);术后CTFC分别为(24.1±8.3)帧与(33.4±15.9)帧,差异有统计学意义(P=0.0062).2组局部心肌血流量(MBF)术后48 h相比无明显差异(P均>0.05),但术后7 d 2组均有明显增加(5.85±1.26与2.09±1.85,t=9.2008,P<0.0001;3.95±1.35与1.95±1.29,t=5.8666,P<0.0001),并且组间比较差异亦有统计学意义(P<0.01).2组在住院期间以及6个月随访左室射血分数(LVEF)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)相比无明显差异(P均>0.05).住院及随访期间严重心力衰竭发生率,A组低于B组,差异有统计学意义(P<0.05).结论 丹参多酚酸盐可以减少急性心肌梗死患者直接PCI中无复流现象的发生,改善心肌再灌注,减少心脏不良事件改善预后.

Effect of polydanshinolate on myocardial reperfusion after percutaneous coronary interventions in patients with acute myocardial infarction

Objective To compare the effect of percutaneons coronary interventions (PCI) combined with polydanshinolate on myocardial reperfusion with PCI combined with regular medicine in patients with acute myocardi-al infrarction ,and whether polydanshinolate would decrease no-reflow,improve the myocardial micro-circulation and the ventricular remodeling and clinical end-point events at the sixth month. Methods Random,parallel control and prospective clinical design was used in the current study. Sixty eligible patients for PCI, who were diagnosed as first-time acute myocardial infrarction with ST stage increasing,were recruited in the study with informed consent. All par-ticipants were divided into two groups randomly. Group A was treated with PCI combined with polydanshinolate, group B was treated with PCI combined with regular medicine. The participants were followed up for six months. The resolution of the sum of ST segment elevation (sum STR) ,corrected TIMI frame count (CTFC) and myocardial con-trast echocardiography (MCE) were used to assess myocardial perfusion. Bleeding events, heart function and major adverse cardiac events (MACE) were observed during hospitalization and follow-up visit. Results No significant difference was observed between two groups on the clinical condition and the results of emergency CAG and PCI. Compared to group B,the incidence of TIMI grade 3 was significantly higher in group A (90.0% vs 63.3% ,χ~2 = 4.565, P=0.0326). Sum STR one hour after PCI in group A was siguificanfly higher than that in group B (80.0% vs 50.0%, χ~2=4.689, P=0.0304). CTFC after PCI also differed significantly between the two groups (24.1±8.3 vs 33.4±15.9 respectively,P=0.0062). Localized myocardial blood flow 48 hours after PCI showed no significant difference between the two groups (P>0.05), whereas both increased at the 7th day after PCI (5.85±1.26 vs 2.09±1.85,t=9.2008,P<0.0001 ;3.95±1.35 vs 1.95±1.29,t=5.8666,P<0.0001) ,and there were signifi-cant difference between the two groups (P<0.05). No significant difference of LVEF, LVEDV, LVESV were found between the two groups during the hospitalization and follow-up visit after 6 months (P>0.05). The incidences of cardiovascular events and severe heart failure during hospitalization and follow-up visit in group A were significantly lower than that in group B (P<0.05 ). Conclusions Polydanshinolate addition to PCI could reduce no reflow phe-nomenan in patients of acute myocardial infrarction, improve myocardial reperfusion, and furthermore, decrease cardi-ovascular events and ameliorate prognosis.