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目的观察米诺环素后处理对急性心肌梗死(AMI)溶栓治疗早期的影响,确定米诺环素能否作为后处理药物减轻心肌缺血再灌注损伤。方法 65例胸痛发作<12 h ST段抬高型AMI患者,随机分为两组。①对照组,32例,尿激酶(UK)静脉溶栓,AMI常规用药;②处理组,33例,米诺环素200 mg静脉推注后UK溶栓,与静脉溶栓同步再予米诺环素200 mg静脉点滴,AMI常规用药。CCU病房24 h观察病情变化,记录心律失常,抽血查心肌酶。结果溶栓后2 h内ST段回落≥50%和>70%的比例,冠状动脉再通的比例,处理组高于对照组(P<0.05)。再灌注心律失常的发生率,处理组低于对照组(P<0.05)。溶栓后24 h内处理组的心肌酶峰值和恶性心律失常发生率明显低于对照组(P<0.05)。结论米诺环素后处理减轻了AMI再灌注损伤,提高了UK溶栓的再通率,降低了再灌注心律失常和恶性心律失常的发生。
Objective To observe the effect of minocycline postconditioning on the early stage of acute myocardial infarction (AMI) thrombolytic therapy and to determine whether minocycline can reduce myocardial ischemia-reperfusion injury as a post-treatment drug. Methods Sixty-five patients with ST-segment elevation AMI who had chest pain onset <12 h were randomly divided into two groups. ① Control group, 32 cases, urokinase (UK) intravenous thrombolysis, AMI routine medication; ② treatment group, 33 cases, minocycline 200 mg after intravenous bolus UK thrombolysis, and intravenous thrombolysis simultaneously mino Ciclopid 200 mg intravenously, AMI conventional medication. CCU ward observation of 24 h changes in condition, record arrhythmia, blood check myocardial enzyme. Results Within 2 hours after thrombolysis, the ratio of ST segment regression ≥50% and> 70%, and the rate of coronary recanalization were higher in the treatment group than in the control group (P <0.05). The incidence of reperfusion arrhythmia in treatment group was lower than that in control group (P <0.05). The incidence of myocardial enzyme peak and malignant arrhythmia in the treatment group within 24 h after thrombolysis was significantly lower than that in the control group (P <0.05). Conclusion Minocycline postconditioning can reduce the reperfusion injury of AMI, increase the recanalization rate of UK thrombolysis, and reduce the incidence of reperfusion arrhythmia and malignant arrhythmia.