曲美他嗪联合运动康复疗法对行 PCI 患者心肌指标及心功能的影响

目的探讨曲美他嗪联合运动康复疗法对冠心病患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后心功能及心肌指标的影响。方法选择2015年5月～2016年8月温州市中医院及温州医科大学附属第二医院收治的120例被确诊为冠心病并行PCI的患者,按照随机数字表法分为对照组、观察组1和观察组2,各40例。对照组采用常规治疗,观察组1在常规治疗基础上给予曲美他嗪治疗,观察组2在曲美他嗪药物治疗的基础上实施康复运动训练。比较PCI术前和术后24 h,三组患者心肌损伤标志物血清肌酸激酶同工酶(creatine kinase MB,CK-MB)、血清心肌肌钙蛋白I(cardiac troponinI,cTnI)以及炎症因子血清高敏C-反应蛋白(high sensitivity C-reactive protein,hs-CRP)的浓度;术后随访12个月,比较三组患者末次随访时的心功能指标、随访期间心血管事件的发生率以及生活质量。结果 PCI术后24 h,三组患者的CK-MB、cTnI、hs-CRP水平均明显高于术前(P0.05),且观察组的水平明显低于对照组(P0.05),观察组1和观察组2的CK-MB、cTnI、hs-CRP水平之间无明显差异(P0.05)。末次随访时,观察组左室射血分数(left ventricular ejection fraction,LVEF)明显高于对照组(P0.05),且观察组2的LVEF明显高于观察组1(P0.05);观察组的左心室收缩末期内径(left ventricular end systolic dimension,LVESD)、左心室舒张末期内径(left ventricular end-diastolic dimension,LVEDD)均明显低于对照组(P0.05),且观察组2的LVESD、LVEDD明显低于观察组1(P0.05)。随访期间,观察组患者心血管事件的发生率明显低于对照组(P0.05),且观察组2的心血管事件发生率明显低于观察组1(P0.05);观察组患者生活质量评分明显高于对照组(P0.05),且观察组2的生活质量评分明显高于观察组1(P0.05)。结论曲美他嗪联合运动康复疗法能有效减轻患者PCI术后心肌损伤,显著改善患者左心室功能,降低心血管事件的发生率,提高患者的生活质量。

Influence of treatment combining trimetazidine and exercise rehabilitation on myocardial indices and cardiac function in patients through PCI

Objective To investigate the influence of treatment combining trimetazidine and exercise rehabilitation on cardiac function and myocardial indices in patients through percutaneous coronary intervention(PCI).Methods 120 patients who were diagnosed as coronary disease and went through PCI in Wenzhou Hospital of Traditional Chinese Medicine and the 2ndAffiliated Hospital of WMU from May 2015 to August 2016 were selected.Patients were divided into control group,observation group 1 and observation group 2 with 40 patients in each by using random number table.Patients in control group were treated with conventional treatment.Patients in observation group 1 were treated with additional trimetazidine based on the conventional treatment while patients in observation group 2 were treated with exercise rehabilitation in addition to the trimetazidine treatment.The concentrations of myocardial indices(creatine kinase MB(CK-MB)and cardiac troponinI(cTnI))and inflammatory factor(high sensitivity C-reactive protein,hs-CRP)in patients before and 24 h after PCI were compared.12-month follow-up visit after operation was paid.Myocardial indices at the last visit,incidence of cardiovascular events during follow-up and life quality in 3 groups of patients were compared.Results The levels of CK-MB,cTnI and hs-CRP in 3 groups of patients 24 h after PCI were significantly higher than those before PCI(P<0.05)and those in observation groups were significantly lower than control group(P<0.05).The levels of CK-MB,cTnI and hs-CRP in observation group 1 were not significantly different from those in observation group 2(P>0.05).At the last visit,left ventricular ejection fraction(LVEF)in observation groups was significantly higher than that in control group(P<0.05)and LVEF in observation group 2 was significantly higher than that in observation group 1(P<0.05).Left ventricular end systolic dimension(LVESD),left ventricular end-diastolic dimension(LVEDD)in observation groups were significantly lower than those in control group(P<0.05).LVESD and LVEDD in observation group 2 were significantly lower than those in observation group 1(P<0.05).During the follow-up visit,the incidence of cardiovascular events in observation groups was significantly lower than that in control group(P<0.05)and the incidence of cardiovascular events in observation group 2 was significantly lower than that in observation group 1(P<0.05).Scores of life quality in observation groups were significantly higher than that in control group(P<0.05)and score of life quality in observation group 2 was significantly higher than that in observation group 1(P<0.05).Conclusion Treatment com bining trimetazidine and exercise rehabilitation could alleviate the myocardial damage after PCI effectively,improve the left ventricular function significantly,reduce the incidence of cardiovascular events and improve life quality.