参附注射液联合瑞替普酶治疗急性ST段抬高型心肌梗死的疗效观察

摘要

目的 探讨急性ST段抬高型心肌梗死(STEMI)应用参附注射液联合瑞替普酶(r PA)治疗的临床疗效及对病人血清基质金属蛋白-9(MMP-9)、超敏C反应蛋白(hs-CRP)、一氧化氮(NO)、内皮素(ET)水平的影响.方法 选择我院2015年1月-2017年4月收治的134例急性STEMI病人,采取随机数字表法分为对照组和观察组.对照组采取r-PA治疗,观察组在此基础上加用参附注射液治疗.记录并比较两组临床疗效,观察两组治疗前后心功能、血清指标水平变化及不良反应情况.结果 治疗14 d后,观察组总有效率较对照组显著升高(P＜0.01).与治疗前比较,两组治疗14d后心功能指标左室射血分数(LVEF)、心输出量(CO)、心脏指数(CI)值均显著升高(P＜0.01);且观察组上述指标的升高程度较对照组更显著(P＜0.01).与治疗前比较,两组治疗14d后血清MMP-9、hs-CRP、ET水平均显著降低(P＜0.01),NO水平显著升高(P＜0.01);且观察组上述指标的改善程度较对照组更显著(P＜0.01).结论 参附注射液联合r-PA治疗急性STEMI可改善病人临床症状体征和心功能,疗效更优,可能与其改善血清中MMP-9、hs-CRP、ET、NO水平有关.%Objective To investigate the clinical efficacy of Shenfu injection combined with reteplase (r-PA) on acute ST elevation myocardial infarction (STEMI) and its influence on the levels of serum matrix metalloproteinase (MMP)-9,hypersensitivity C reactive protein (ha-CRP),nitric oxide (NO),and endothelin (ET) in patients.Methods The subjects of this study were selected from 134 cases of patients with acute STEMI admitted in our hospital from January 2015 to July 2017,who were evenly divided into two groups on the basis of random number table.The control group was treated with r PA,while the observation group shenfu injection in addition to which was applied to the control group.The clinical efficacy,changes of heart function,and serum indicators before and after treatment,as well as adverse reactions were recorded and compared between the two groups.Results After 14 days of treatment,the total effective rate in observation group was higher than that in control group (P ＜0.01).Compared with those before treatment,the heart function indexes indexes including left ventricular ejection fraction (LVEF),cardiac output (CO),and cardiac index (Cl) of both groups after 14 days of treatment increased significantly (P ＜0.01),and the increase in the above indicators in the observation group was remarkably higher than that in the control group (P ＜0.01).After 14 days of treatment,both groups,serum MMP 9,hs CRP,ET levels were decreased significantly and NO level was increased as compared with those before treatment (P ＜0.01),The incidence of adverse reactions of the observation group was 13.4％,there was no difference from 16.4％ of the control group (P ＞0.05).Conclusion The combination of shenfu injection and e PA in treating acute STEMI has a better effect in eliminating clinical symp toms in patients and improving their heart function,which may be related to its effect in improving the levels of serum MMP-9,hs CRP,ET,and NO.