术前负荷剂量rhBNP对急性前壁心肌梗死行急诊经皮冠状动脉介入时冠脉无复流的干预作用

摘要

Objective To investigate the effect of bolus intravenous injection of recombinant human brain natriuretic peptide (rhBNP) before primary percutaneous coronary intervention (PCI) on coronary no-reflow in patients with anterior wall acute myocardial infarction (AMI).Methods Eighty consecutive patients with anterior wall AMI after Primary PCI were randomly divided into therapy group(n =40) and control group (n =40).Patients in therapy group were treated with bolus intravenous injection of rhBNP (1.5 μg/kg).Both the control and the therapy group received conventional treatment.The neuroendocrine hormone level,inflammato ry factor level and ventricular function were measured upon admission and 7 days later.The incidence of coronary no-reflow in both groups was observed during PCI.Results The incidence of coronary no-reflow and reperfusion arrhythmia in therapy group markedly decreased compared with control group (P ＜ 0.05).No adverse events during drug infusion were observed and MACE during hospitalization was also similar in both groups.Conclusions Patients with anterior wall AMI before primary PCI treated with bolus intravenous injection of rhBNP can markedly decrease the coronary no-reflow and reperfusion arrhythmia.%目的 探讨术前负荷剂量重组人脑利钠肽(recombinant human brain natriuretic peptide,rhBNP)对行急诊经皮冠状动脉介入(PCI)治疗的急性前壁心肌梗死患者冠脉无复流的干预作用.方法 序贯入选80例在武警天津总队医院行急诊PCI治疗的急性前壁心肌梗死患者,随机分为治疗组和对照组.治疗组PCI术前在常规药物治疗的基础上以1.5 μg/kg负荷剂量静推rhBNP;对照组单纯给予常规药物治疗;比较两组患者PCI术中冠脉无复流的发生情况.结果 治疗组在给药后冠脉无复流(2.5％vs 15.0％)及再灌注心律失常的比例明显低于对照组,差异有统计学意义.rhBNP相关的严重不良反应比较,两组住院期间主要心血管事件发生率无明显差异.结论 急性前壁心肌梗死患者急诊PCI术前应用负荷剂量rhBNP可显著改善冠脉血流,减少再灌注心律失常的发生.