前列地尔对冠状动脉介入术后无复流患者左心室功能和心血管事件的影响

目的：观察前列地尔脂微球载体制剂（Lipo-PGE1）对急性广泛前壁心肌梗死并完全性右束支传导阻滞（RBBB）经冠状动脉介入治疗（PCI）后无复流患者左心室功能和心血管事件的影响。方法：102例确诊急性广泛前壁心肌梗死并完全性RBBB的患者,且所有患者均从发病至到达我院行直接PCI时间〈12h,术后血流只达到TIMI2级,且完全性RBBB仍存在,予随机分为治疗组及对照组。治疗组予生理盐水20mL加Lipo-PGE120μg静脉缓慢推注2次/d,共3d;对照组予硝酸甘油用5%葡萄糖稀释（糖尿病患者用生理盐水）50～100μg/min持续静脉缓慢滴注3d。两组患者均予心电监护、心电图检查及彩色多普勒二维结果：治疗组与对照组在术后住院期间LVDd、LVEF均无显著性差异。随访1年,治疗组患者的LVDd明显降低,LVEF明显提高,与对照组相比差异均有显著性,P〈0.05;术后1周内治疗组中完全性RBBB消失的例数多于对照组,室性心动过速的病例数少于对照组,差异有显著性,P〈0.05。结论：对于急性心肌梗死患者经PCI术后存在无复流现象,经应用Lipo-PGE1可改善心肌微循环,挽救更多濒死心肌,减少心律失常发生,从而达改善心泵功能,提患者生活质量。

The Affect of Alprostadil on Left Ventricular Function and Cardiovascular Events in the No-reflow Coronary Patients with Acute Myocardial Infarction and Complete Right Bundle Branch Block After Coronary Intervention

Objective：To observe the influence of alprostadil Lipo agents （Lipo-PGE1）on left ventricular function and cardiovascular events in the no-reflow coronary patients with acute extensive anterior wall myocardial infarction and complete right bundle branch block （RBBB） after percutaneous coronary intervention （PCI）.Methods：102 cases diagnosed with acute extensive anterior wall myocardial infarction and complete RBBB performed direct PCI in our hospital within onset time 12 h,their coronary blood flow only reached TIMI 2 grade,and complete RBBB was still exist,all the patients were randomly divided into treatment group and control group.the patients in treatment group were given saline 20ml plus Lipo-PGE1 20μg slow bolus intravenous Bid for 3 days;the control group was given the nitroglycerin dilution with 5% glucose （diabetes patients with a normal saline） 50～100 μg/min intravenous drip continuance for 3 days.Two groups undertook Conventional ECG,ECG and color Doppler echocardiography examination.Results：There was no significant difference between the treatment group and control group in LVDd,LVEF during the postoperative hospital treatment.Follow-up a year,LVDd in the treatment group significantly decreased while LVEF significantly improved compared with control group P〈0.05;the complete RBBB disappeared in the most of cases of treatment group within one week after PCI,the incidence of ventricular tachycardia is less in the treatment group than that in the control group,their difference was significant,P〈0.05.Conclusions：No-reflow phenomenon can be seen in the patients with acute myocardial infarction patients after PCI,Lipo-PGE1 can improve the myocardial microcirculation,save more moribund myocardium,reduce incidence of arrhythmia,and improve cardiac pump function,improve the quality of life.