麝香通心滴丸联合血栓抽吸改善 STEMI 患者 PCI 术后心肌血流灌注的临床研究

摘要

[ABSTRACT]Objective:To study the effect of Shexiang Tongxin Dropping Pill combined with thrombus aspiration on im-proving myocardial perfusion after PCI in patients with STEMI.Methods:A total of 104 patients with STEMI who received e-mergency PCI combined with thrombus aspiration in our hospital between May 2013 and October 201 5 were selected as the re-search subjects and randomly divided into two groups:observation group received perioperative antiplatelet combined with Shexiang Tongxin Dropping Pill therapy,and the control group received perioperative antiplatelet therapy alone.Before treat-ment and 3 days after treatment,serum myocardial injury indexes,endothelial injury indexes and RAS system indexes were de-termined;4 weeks after treatment,serum ventricular remodeling indexes were determined.Results:Three days after treat-ment,serum CK,CK-MB,cTnI,cTnT,ET-1,vWF,PRA,AngII and ALD levels of both groups were significantly lower than those before treatment while NO level was significantly higher than that before treatment;serum CK,CK-MB,cTnI,cT-nT,ET-1,vWF,PRA,AngII and ALD levels of observation group 3 days after treatment were significantly lower than those of control group while NO level was significantly higher than that of control group;4 weeks after treatment,serum PICP,IC-TP,PIIINP,HSP47 and GDF-1 5 levels of observation group were significantly lower than those of control group.Conclusions:Shexiang Tongxin Dropping Pill application during perioperative period of PCI combined with thrombus aspiration can reduce myocardial cell damage and endothelial function injury as well as inhibit RAS system activation and ventricular remodeling.%目的：：研究麝香通心滴丸联合血栓抽吸对 ST 段抬高型心肌梗死(ST elevation myocardial in-farction,STEMI)患者经皮冠状动脉介入治疗(PCI)术后心肌血流灌注的改善作用。方法：选择2013年5月~2015年10月期间在我院接受急诊 PCI 联合血栓抽吸治疗的104例 STEMI 患者作为研究对象,随机分为两组,观察组在围手术期给予抗血小板联合麝香通心滴丸治疗,对照组在围手术期仅给予抗血小板治疗。治疗前和治疗后3 d 时,测定血清中心肌损伤指标、内皮损伤指标以及 RAS 系统指标；治疗后4周时,测定血清中心室重构指标。结果：治疗后3 d 时,两组血清中肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白 I(cTnI)、心肌肌钙蛋白 T(cTnT)、内皮素-1(ET-1)、血管性血友病因子(vWF)、肾素(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)的含量均显著低于治疗前,一氧化氮(NO)含量显著高于治疗前；观察组治疗后3 d 时血清中 CK、CK-MB、cTnI、cTnT、ET-1、vWF、PRA、AngⅡ、ALD 的含量均显著低于对照组,NO 的含量显著高于对照组；治疗后4周时,观察组血清中 I 型前胶原羧基端肽(PICP)、I 型 C 端胶原前肽(ICTP)、Ⅲ型前胶原氨基端肽(PⅢNP)、热休克蛋白47(HSP47)、分化生长因子15(GDF15)的含量均显著低于对照组。结论：PCI 联合血栓抽吸围手术期应用麝香通心滴丸能够减轻心肌细胞损伤以及内皮功能损伤、抑制 RAS 系统激活以及心室重构。