应用主动脉内球囊反搏对急性心肌梗死急诊经皮冠状动脉介入术后慢血流现象患者血浆脑钠肽水平及左室功能的影响

目的探讨应用主动脉内球囊反搏(IABP)对急性ST段抬高心肌梗死(STEMI)冠状动脉介入治疗术后慢血流(SCF)患者血浆脑钠肽(BNP)水平及左心室功能的影响。方法分析2008年1月—2010年12月因STEMI行PCI术后SCF现象患者28例资料,采用单双日分组方法将其中14例运用IABP治疗分为治疗组,其余14例为对照组,观察术后1h心电图梗死相关导联ST回落及术前、术后24h、术后1周BNP水平差异;治疗10d后应用彩色超声心动图测量患者左心房内径、左心室内径、左心室射血分数(LVEF);并随访3个月、6个月左心房内径、左心室内径、LVEF变化情况。结果术后1h心电图ST回落50%者对照组组占28.1%,治疗组占61%;术前两组BNP水平无明显差异,术后24h对照组为(365.1±121.6)ng/L,治疗组为(278.4±92.7)ng/L;术后1周对照组为(295.7±65.8)ng/L,治疗组为(203.8±64.7)ng/L,P<0.05。超声心动图测量两组患者恢复期LVEF值差别有明显统计学意义。结论急性STEMI患者直接PCI术后SCF现象患者应用IABP明显影响BNP水平,提高恢复期LVEF值,对心功能可能有一定的改善作用。

Effects of Intra-aortic Balloon Pumping on Plasma Brain Natriuretic Peptide and Left Ventricluar Function in Patients with Slow Coronary Flow Phenomenon after Primary Percutaneous Coronary Intervention

Objective To evaluate the effects of intra-aortic balloon pumping(IABP) on plasma brain natriuretic peptide(BNP) level and left ventricular remodeling function in patients with slow coronary flow phenomenon after primary percutaneous coronary intervention(PCI) in acute myocardial infarction(AMI).Methods A total of 28 AMI patients with slow coronary flow phenomenon after primary PCI between January 2008 and September 2010 were enrolled,and randomly divided into the IABP treatment group or control group.Electrocardiogram was measured 1 hour after PCI in each patient.Plasma levels of BNP were detected before PCI,24 hours and 1 week after PCI.Echocardiography was measured 10 days,3 months and 6 months after PCI.Results In the IABP group,61% subjects showed ST segment resolution ≥50% 1 hour after PCI,while 28.1% in the control group.Plasma BNP before PCI between 2 groups was comparable.In the IABP group,plasma BNP level was decreased from 24 hours after PCI when compared with the control group((278.4±92.7)ng/L vs.(365.1±121.6)ng/L).Future reduced plasma BNP level was observed in the IABP group 1 week after PCI compared with the control group((203.8±64.7)ng/L vs.(295.7±65.8)ng/L,P<0.05).The LVEF in the IABP group compared to the control after 3 months and 6 months were 55.19% vs 53.21% and 59.24% vs 52.38% respectively(P=0.0075).Conclusion Application of intra-aortic balloon pumping after primary PCI could significantly reduce plasma BNP,with improvement of cardiac function in patients with slow coronary flow phenomenon.