| 陈春望,钱文浩,丁 浩,周 浩,王万虹.沙库巴曲缬沙坦对急性前壁心肌梗死急诊PCI术后合并心功能不全患者近期预后的影响[J].,2019,19(19):3720-3725 |
| 沙库巴曲缬沙坦对急性前壁心肌梗死急诊PCI术后合并心功能不全患者近期预后的影响 |
| Effect of Shakuba Trivalsartan on the Short-term Prognosis of Patients with Acute Anterior Wall Myocardial Infarction Complicated with Cardiac Insufficiency after Emergency PCI |
| 投稿时间：2019-05-23 修订日期：2019-06-18 |
| DOI：10.13241/j.cnki.pmb.2019.19.028 |
| 中文关键词: 急性心肌梗死 经皮冠状动脉介入治疗 心功能不全 |
| 英文关键词: Acute Myocardial Infarction Peacutaneous Coronary Intervention cardiac insufficiency |
| 基金项目:江苏省卫生国际交流支撑计划项目(JSWSGJ2016366) |
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| 中文摘要: |
| 摘要 目的：研究沙库巴曲缬沙坦对急性前壁心肌梗死急诊经皮冠状动脉介入治疗(primary peacutaneous coronary intervention，PCI)术后合并心功能不全患者近期预后的影响。方法：选择2018年1月~2019年1月在我院就诊并入院接受治疗的52例急性前壁心肌梗死急诊PCI术后合并心功能不全患者患者，采用随机数字表法将其分为两组，每组各26例。观察组在常规治疗的基础上使用沙库巴曲缬沙坦，对照组在常规治疗基础上应用依那普利治疗。分别比较两组患者入组后、出院前1 d及随访时血浆肌钙蛋白(Ⅰcardiac troopingⅠ，cTnI)、肌酸激酶同工酶(Creatine kinase-MB，CK-MB)、超敏C反应蛋白(High-sensitivity creactive protein，hs-CRP)、纤维蛋白原(Fibrinogen，FIB)、肿瘤坏死因子-α(Tumor necrosis factor，TNF-α)、肌酐(Creatine，CREA)、N末端脑钠肽前体(N-terminal-pro-brain-natriuretic-peptide，NT-proBNP)、左室舒张末期前后径( Left ventricular end-diastolic diamete，LVEDD)、左室射血分数(Left ventricular ejection fraction，LVEF)、左室质量指数(Left ventricular mass index，LVMI)、美国堪萨斯城心肌病患者生存质量表（Kansas City Cardiomyopathy Questionnaire，KCCQ）评分、6 min步行试验(6MWT)、临床事件及不良反应的发生情况。结果：①出院前1 d，两组患者的血清cTnI、hs-CRP、NT-proBNP、CK-MB、FIB 、TNF-α、CREA水平均比治疗前明显下降(P<0.05)；出院1周时，观察组的血清cTnI、hs-CRP、NT-proBNP、CK-MB水平与对照组比较无统计学差异(P>0.05)；出院2周、1个月时，观察组的血清cTnI、hs-CRP、NT-proBNP、CK-MB水平均明显低于对照组(P<0.05)。治疗后的各个随访时间点，两组患者的血清FIB、TNF-α、CREA水平均比治疗前明显降低(P<0.05)，但组间差异无统计学意义(P>0.05)。②两组在出院前1 d LVEF、LVEDD、LVMI水平比较差异无统计学意义(P>0.05)。出院后1、3、6个月时，观察组以上指标的改善幅度显著优于对照组(P<0.05)。两组患者在接受治疗前收缩压(SBP)和舒张压(DBP)无统计学差异(P>0.05)，治疗后上述指标均显著下降(P<0.05)。但两组在随访过程中各个时点的收缩压和舒张压无统计学差异(P>0.05)。③两组患者治疗后KCCQ生存质量评分较治疗前显著升高(P<0.05)，且治疗3个月和6个月时，观察组的KCCQ生存质量评分显著高于对照组(P<0.05)。观察组临床事件及不良反应的发生率均显著低于对照组(P<0.05)。结论：沙库巴曲缬沙坦和依那普利用于急性心肌梗死PCI术后合并心功能不全患者的疗效相当，但沙库巴曲缬沙坦治疗的患者近期预后优于依那普利。 |
| 英文摘要: |
| ABSTRACT Objective: To study the Shakurba valsartan on acute anterior wall myocardial infarction emergency percutaneous coronary intervention postoperative combined effect of the recent outcomes for patients with cardiac insufficiency. Methods: From January 2018 to January 2019 in our hospital 52patients was admitted to hospital as the research object, using the random number table method divided the patients into observation group and control group, 26 caseseach group, observation group on the basis of conventional treatment using Shakurba valsartan, and the control group on the basis of conventional treatment of enalapril application. Respectively in the patient group, 1 day before discharge and follow-up after plasma troponin detection cardiac trooping Ⅰ(cTnI), creatine kinase isoenzyme (CK-MB), hypersensitive c-reactive protein(hs-CRP), fibrinogen(FIB), tumor necrosis factor alpha (TNF-α), CREA, n-terminal-pro-brain-natriuretic -peptide (nt-Probnp), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and left ventricular quality index (LVMI) were measured by color doppler ultrasound. KCCQ scale score, 6-minute walk test (6MWT); The incidence of clinical events and adverse reactions was calculated. Results: (1) 1 day before discharge, cTnI, hs-crp, nt-probnp, ck-mB, FIB, TNF-α, CREA of the two groups were significantly lower than before treatment, the difference was statistically significant (P<0.05). At 1 week after discharge, the levels of cTnI, hs-crp, nt-probnp and ck-mB in the observation group were not significantly different from those in the control group (P>0.05). At 2 weeks and 1 months after discharge, the levels of cTnI, hs-CRP, nt-Probnp and CK-MB in the observation group were significantly lower than those in the control group (P<0.05). FIB, TNF-α and CREA in the two groups were significantly lower at each time point after treatment than before treatment, with statistically significant differences (P<0.05), but no significant differences between the two groups (P>0.05). (2) There was no significant difference in LVEF, LVEDD, and LVMI levels between the two groups at 1 day before discharge (P>0.05). At 1, 3, and 6 months after discharge, the improvement of the above indicators was significantly better than that of the observation group. Control group (P<0.05). There was no significant difference in SBPand DBPbetween the two groups (P>0.05). After treatment, the above indexes were significantly decreased (P<0.05). However, there was no significant difference in systolic and diastolic blood pressure between the two groups at each time point during follow-up (P>0.05). (3) The KCCQ score of the two groups was significantly higher after treatment than before treatment, and the difference was statistically significant (P<0.05). At 3 months and 6 months after treatment, the observation group was significantly higher than the control group, and the difference was statistically significant (P<0.05). The incidence of clinical events and adverse reactions in the observation group was lower than that in the control group (P<0.05). Conclusion: For patients with acute myocardial infarction combined with cardiac insufficiency after PCI, the efficacy of shakurba valsartan and enalapril is comparable, but the short-term prognosis of shakurba valsartan is better than that of enalapril. |
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