急性心肌梗死直接PCI联合静脉应用重组人脑利钠肽对左心室重构和功能的影响

目的:探讨直接经皮冠状动脉介入治疗(PCI)联合静脉应用重组人脑利钠肽(rhBNP)对急性心肌梗死(AMI)患者左心室重构和左心功能的影响。方法:将82例初次急性ST段抬高急性前壁心肌梗死行直接PCI患者分为两组:rhBNP组(n=42)和对照组(n=40)。rhBNP组在常规药物治疗基础上,于直接PCI术后即刻予以常规剂量静脉应用rhBNP,对照组单纯给予常规药物治疗。两组患者于发病后1、12、24周行二维超声心动图检查,并随防半年内心脏事件的发生。结果:24周随访,rhBNP组左心室心肌重量(LVMWg)、左室舒张末容积(EDV)、左室收缩末容积(ESV)、左室射血分数(EF)及室壁运动指数(WMSI)均显著优于对照组(P<0.01)。rhBNP组患者半年后在心力衰竭和复合终点事件方面较对照组明显下降(P<0.01)。结论:直接PCI术后在常规治疗的基础上应用rhBNP可进一步抑制急性前壁心肌梗死后左心室重构,改善左心功能,并显著减少心脏事件的发生。

Efects of intravenous recombinant human brain natriuretic peptide after primary PCI on ventricular remodeling and ventricular function in patients with acute myocardial infarction

Objective To investigate the effects of intravenous recombinant human brain natriuretic peptide（rhBNP）after primary percutaneous coronary intervention（PCI）on ventricular remodeling and ventricular function in patients with acute myocardial infarction（AMI）.Method Total 82 patients with a first acute ST-segment elevation myocardial infarction after primary PCI were randomly divided into the rhBNP group（n=42）and the control group（n=40）.Transvenous injection of rhBNP combined with other routine treatments were used in the rhBNP group after primary PCI;while only routine treatments were used in the control group.Patients all accepted two-dimensional echocardiography in 1st,12th and 24th week after infarction,and followed up occurrence of major cardiac events within half a year.Results In the 24th week after infarction,compared with the control group,the left ventricular myocardium weight（LVMWg）,end-diastolic volume（EDV）,end-systolic volume（ESV）,left ventricular ejection fraction（LVEF）,and regional wall motion score index（WMSI）were significantly improved in the rhBNP group（P0.01）.Half a year later,compared with the control group,heart failure and composite events（P0.01）were significantly decreased in the rhBNP group.Conclusion Transvenous injection of rhBNP combined with other routine treatments can further inhibit the remodeling of left ventricular and improve the left ventricular function,so as to desease significantly occurrence of cardiac events.