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目的:探讨主动脉内球囊反搏(IABP)在急性心肌梗死(AMI)急诊冠状动脉介入治疗(PCI)术后无复流(NR)现象中的治疗作用。方法:分析自2006-01-2010-08期间因AMI行PCI术后NR患者30例资料,采用单双日法分组方法将其中16例运用IABP治疗,其余未用IABP的14例为对照组,观察术后10d内心肌损伤标志物、脑钠肽(BNP)及血管活性物质恢复情况。心肌损伤标志物包括肌红蛋白、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI);血管活性物质指标包括肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、肾上腺素(E)、去甲肾上腺素(NE);治疗10d后应用彩色超声心动图测量患者左房内径、左室内径、左室射血分数(LVEF);并随访3个月、6个月左房内径、左室内径、LVEF变化情况。结果:IABP治疗组患者血管活性物质及心肌损伤标志物指标时间-浓度曲线显示指标下降明显快于对照组,2组间血管活性物质及心肌损伤标志物与对照组相比,2组下降幅度差异有统计学意义(P<0.05);IABP组BNP峰值较对照组提前,IABP治疗组BNP指标时间-浓度曲线显示指标下降明显快于对照组,2组间BNP指标下降与对照组相比差异无统计学意义(P>0.05);超声心动图测量2组患者10d、3个月及6个月时左房内径、左室内径及LVEF差异有统计学意义(P<0.05)。结论:IABP能够加速降低AMI急诊PCI术后发生NR患者升高的交感神经系统、RAS系统激素及心肌损伤标志物的水平;使BNP峰值提前并改善10d、3个月及6个月时左房内径、左室内径及射血分数值。
Objective: To investigate the therapeutic effect of intra-aortic balloon pump (IABP) on no-reflow (NR) after emergency percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI). Methods: The data of 30 patients with NR after PCI for AMI during 2006-01-2010-08 were analyzed. Among them, 16 cases were treated with IABP by single-and double-day method, and 14 cases without IABP as control group. The recovery of myocardial injury markers, brain natriuretic peptide (BNP) and vasoactive substances within 10 days after operation were observed. Myocardial injury markers include myoglobin, creatine kinase (CK-MB) and troponin I (cTnI); vasoactive substances include renin activity (PRA), angiotensin II (ALD), epinephrine (E) and norepinephrine (NE). Left atrium diameter, left ventricular diameter and left ventricular ejection fraction (LVEF) were measured by color echocardiography after 10 days of treatment. , 6 months left atrial diameter, left ventricular diameter, LVEF changes. Results: The time-concentration curve of indicators of vasoactive substances and myocardial injury in IABP treatment group showed that the index decreased significantly faster than that of control group. There was significant difference between the two groups in the decrease of vasoactive substances and myocardial injury markers (P <0.05). The BNP peak value of IABP group was earlier than that of control group. The time-concentration curve of BNP index in IABP treatment group showed that the index decreased significantly faster than that of control group. The difference of BNP index between the two groups was not significant Statistical significance (P> 0.05). Echocardiography measured left atrial diameter, left ventricular internal diameter and LVEF at 10 days, 3 months and 6 months in two groups were statistically significant (P <0.05). CONCLUSIONS: IABP can accelerate the decrease of the elevated sympathetic nervous system, RAS system hormones and myocardial injury markers in NR patients after AMI. The peak of BNP is advanced and the left atria are improved at 10 days, 3 months and 6 months Diameter, left ventricular diameter and ejection fraction values.