【摘要】 目的:探讨乌司他丁(UTI)预处理对急诊冠状动脉介入治疗(PCI)患者心肌缺血再灌注损伤的影响。方法:将120例急性心肌梗死(AMI)患者随机分成两组:试验组(n=62)采用UTI预处理+常规PCI治疗,对照组(n=58)采用常规PCI治疗,比较两组患者PCI术前和术后2 h、12 h、24 h、72 h的肌钙蛋白I(cTnI)、超敏C反应蛋白(hs-CRP)水平、再灌注心律失常的发生率和术后7天SPECT静息心肌灌注显像、治疗后3个月心功能情况和主要不良心血管事件(MACE)发生率。结果:两组术前cTnI、hs-CRP水平无明显差异(P>0.05),试验组术后各时点cTnI、hs-CRP水平明显低于对照组(P<0.05);试验组再灌注心律失常的发生率明显少于对照组(P<0.05);SPECT半定量分析显示术后第7天心肌缺血面积、心肌坏死面积试验组均明显小于对照组(P<0.05,P<0.01);随访3个月,试验组患者心功能明显改善,且MACE发生率低于对照组(P<0.05)。结论:UTI可显著减轻急诊PCI患者心肌缺血再灌注损伤,减轻炎症反应,减少心肌坏死,保护心功能,改善患者预后。更多还原

【Abstract】 Objective:To explore the effect of pretreatment of ulinastatin(UTI) on myocardial ischemia reperfusion injury during emergency percutaneous coronary interventional(PCI).Methods:120 patients with acute myocardial infarction(AMI)were randomly assigned to two groups:the test group(n=62)received UTI pretreatment and conventional PCI,while the control group(n=58)received conventional PCI. The levels of Troponin I(c Tn I)and hypersensitive creactive protein(hs-CRP)on preoperative and postoperative 2 h、12 h、24 h、72 h,the incidence of reperfusion arrhythmia and rest single photon emission computed tomography(SPECT)seven days after PCI,cardiac function and the incidence of major adverse cardiac events(MACE)after 3 months were compared between the two groups. Results:The concentration of preoperative c Tn I、hs-CRP in the two groups were no obvious difference(P>0.05).At postoperative each time,the concentration of c Tn I、hs-CRP in test group were significantly lower than those in the control group(P<0.05).Compared with the control group,the test group had lower incidence of reperfusion arrhythmia(P<0.05).The test group had less ischemic and infarct size measured by SPECT seven days after PCI than that in the control group(P<0.05,P<0.01).Followed up for 3 months,the heart function of test group improved significantly,and the incidence of MACE was lower than that in the control group(P<0.05).Conclusion:The study indicates that UTI can significantly reduce myocardial ischemia reperfusion injury,decrease inflammation,reduce myocardial necrosis,protect cardiac function,and improve the prognosis for emergent PCI cases.更多还原