凯时对急性心肌梗死急诊经皮冠状动脉介入治疗后心肌灌注的影响

目的评价急诊经皮冠状动脉介入治疗（PCI）术联合应用凯时（前列腺素E1）对术后心肌灌注的影响。方法将58例接受急诊PCI治疗且符合术前梗死相关血管完全闭塞（血流TIMI0级或1级），PCI治疗后梗死相关血管达到血流TIMI3级的急性心肌梗死患者随机分为凯时组28例和对照组30例。比较两组临床特征、心肌呈色分级（MBG）、心电图ST段回落指数（sumSTR）及住院期间主要心血管事件、左室射血分数。结果两组基础临床情况及造影特征无明显差异。凯时组心肌呈色分级2／3级获得率明显增高（71．4％vs43．3％，P〈0．05），术后心电图ST段回落指数（sumSTR）≥50％的比例更高（82．1％vs53．3％，P〈0．05）。心肌梗死1周后射血分数亦高于对照组（57．3％±5．4％vs47．2％±7．2％，P〈0．05）。两组住院期间主要心血管事件差异无统计学意义（P〉0．05）。结论急性心肌梗死患者在急诊PCI基础上，联合凯时治疗可改善心肌灌注，改善患者心功能，近期疗效好，无不良反应。

Effect of Prostaglandin E1 on Myocardial Perfusion in Patients with ST-segment Elevated Myocardial Infarction Under-going Primary Percutanous Coronary Intervention

Objective To investigate the effect of prostaglandin E1 on myocardial perfusion in pations with ST -segment elevated myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention （PCI）. Methods Fifty eight patients who presented with acute STEM1 and received successful primary PCI were enrolled into the study. All patients had angiographic evidence of initial total occlusion of infarct - related artery and finally restored to TIMI 3 flow after PCI. All the patients were grouped into the prostaglandin E1 group （n = 28） and the control group （n = 30） according to whether prostaglandin E1 was used or not. Assessment of myocardial perfution included Myocardial Blush Grade （ MBG）, and the resolution of the sum of ST- segment elevation （sumSTR） at 90 minutes after the procedure. Left ventricular ejection fraction （EF） was measured one week later. Major adverse carciac events in hospital was also assessed. Results Baseline clinical and angiographic characteristics of the two groups were similar. Significant higher rates of MBG 2/3 were observed in the prostaglandin E1 group（71.4% vs 43.3%, P 〈 0.05 ）. Also significant higher rates of sumSTR≥50% were observed in the prostaglandin E1 group （82. 1% vs 53. 3%, P 〈0. 05）. Ejection fraction was also increased markedly in the prostaglandin E1 group than the control group （57. 3% ±5.4% vs 47. 2% ±7.2% , P 〈0.05）. In -hospital major adverse cardiac events were not different between the two groups. Conclusion Prostaglandin E1 can further ameliorate microvascular perfusion and is safe and feasible for patients with STEM1 undergoing primary PCI.