發(fā)布時(shí)間：2018-02-07 13:05

  本文關(guān)鍵詞： 丹參多酚酸鹽 急性ST段抬高型心肌梗死 缺血-再灌注損傷 校正的TIMI幀數(shù) R波 ST段　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過對(duì)急性心肌梗死患者急診PCI術(shù)前應(yīng)用丹參多酚酸鹽,計(jì)數(shù)梗死相關(guān)動(dòng)脈開通后校正的TIMI幀數(shù)評(píng)估冠狀動(dòng)脈血流,計(jì)量梗死相關(guān)動(dòng)脈開通前后心電圖相關(guān)導(dǎo)聯(lián)ST段及R波振幅的變化值評(píng)估對(duì)心肌缺血-再灌注損傷的影響,探討急性心肌梗死患者缺血-再灌注損傷的藥物治療方法。方法:選取2016年1月至2016年12月我院心血管內(nèi)科確診為急性ST段抬高型心肌梗死患者80例,且發(fā)病時(shí)間短于12小時(shí),隨機(jī)分為試驗(yàn)組及對(duì)照組,所有入組患者均于術(shù)前嚼服拜阿司匹林300mg、替格瑞洛180mg,試驗(yàn)組在常規(guī)口服藥物基礎(chǔ)上加用丹參多酚酸鹽200mg靜點(diǎn)。分別于梗死相關(guān)動(dòng)脈球囊開通即刻、開通后5分鐘、開通后10分鐘計(jì)數(shù)冠狀動(dòng)脈血流充盈至遠(yuǎn)段分支的校正的TIMI幀數(shù),分別于梗死相關(guān)動(dòng)脈球囊開通前5分鐘、開通后即刻、開通后5分鐘、開通后10分鐘計(jì)量心電圖相關(guān)導(dǎo)聯(lián)ST段及R波振幅的變化值,對(duì)每組患者組內(nèi)及兩組患者之間不同時(shí)段上述監(jiān)測(cè)指標(biāo)進(jìn)行統(tǒng)計(jì)學(xué)分析,比較其差異。結(jié)果:1兩組病例基線指標(biāo),即年齡、梗死相關(guān)動(dòng)脈開通前5分鐘ST段抬高值、R波振幅及梗死相關(guān)動(dòng)脈開通后即刻校正的TIMI幀數(shù)無統(tǒng)計(jì)學(xué)差異(P0.05)。2對(duì)照組梗死相關(guān)動(dòng)脈開通后即刻、5分鐘、10分鐘時(shí)ST段抬高值分別為(0.3580±0.06354)mv、(0.3343±0.06827)mv、(0.3320±0.06888)mv,R波振幅分別為(1.4353±0.20666)mv、(1.4010±0.19525)mv、(1.3720±0.18582)mv,均無統(tǒng)計(jì)學(xué)意義(P0.05)。梗死相關(guān)動(dòng)脈開通后5分鐘、10分鐘校正的TIMI幀數(shù)分別為(30.2625±5.62844)幀、(29.5500±5.79434)幀,提示梗死相關(guān)動(dòng)脈開通后5分鐘、10分鐘與基線比較均有統(tǒng)計(jì)學(xué)意義(P0.05),但梗死相關(guān)動(dòng)脈開通后5分鐘與開通后10分鐘相比無統(tǒng)計(jì)學(xué)意義(P0.05)。3試驗(yàn)組梗死相關(guān)動(dòng)脈開通后即刻、5分鐘、10分鐘時(shí)ST段抬高值分別為(0.3522±0.06233)mv、(0.3203±0.06538)mv、(0.2695±0.07531)mv,提示開通后即刻與基線相比無統(tǒng)計(jì)學(xué)意義(P0.05),開通后5分鐘、10分鐘與基線及開通后即刻相比均有統(tǒng)計(jì)學(xué)意義(P0.05),開通后10分鐘與開通后5分鐘相比仍有統(tǒng)計(jì)學(xué)意義(P0.05)。R波振幅分別為(1.3875±0.18403)mv、(1.3838±0.18422)mv、(1.3810±0.18282)mv,均無統(tǒng)計(jì)學(xué)意義(P0.05)。梗死相關(guān)動(dòng)脈開通后5分鐘、10分鐘校正的TIMI幀數(shù)分別為(27.1125±4.72512)幀、(24.4125±5.00242)幀,提示開通后5分鐘、10分鐘與基線比較均有統(tǒng)計(jì)學(xué)意義(P0.05),開通后5分鐘與開通后10分鐘相比仍有統(tǒng)計(jì)學(xué)意義(P0.05)。4組間對(duì)比,對(duì)照組與實(shí)驗(yàn)組ST段抬高值在梗死相關(guān)動(dòng)脈開通后10分鐘對(duì)比有統(tǒng)計(jì)學(xué)意義(P0.05),其它時(shí)間段對(duì)比無統(tǒng)計(jì)學(xué)意義(P0.05),R波振幅組間不同時(shí)間段對(duì)比均無統(tǒng)計(jì)學(xué)意義(P0.05),校正的TIMI幀數(shù)在開通后5分鐘、10分鐘對(duì)比均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1丹參多酚酸鹽可有效抑制心肌缺血-再灌注損傷,起效時(shí)間早,且隨時(shí)間延長(zhǎng)獲益增加。2丹參多酚酸鹽可改善冠狀動(dòng)脈微循環(huán)灌注。
[Abstract]:Objective: to count the corrected TIMI frame number of infarct related artery to evaluate coronary artery flow by using salvia miltiorrhiza polyphenolic acid before emergency PCI in patients with acute myocardial infarction. The effects of St segment and R wave amplitude on myocardial ischemia-reperfusion injury were measured before and after the opening of infarct related artery. Methods: from January 2016 to December 2016, 80 patients with acute ST-segment elevation myocardial infarction were diagnosed as acute ST-segment elevation myocardial infarction, and the onset time was less than 12 hours. They were randomly divided into the experimental group and the control group. All the patients in the study group were chewed with Aspirin 300 mg and tigrilol 180 mg before the operation. The experimental group was treated with salvia miltiorrhiza (200mg) on the basis of routine oral medication, respectively, immediately after the balloon of infarct related artery was opened. The corrected TIMI frames of coronary artery filling to the distal branch were counted 5 minutes before the opening of the infarct-related artery balloon, immediately after the opening, 5 minutes after the opening, 10 minutes after the opening of the coronary artery, 10 minutes after the opening of the coronary artery, and 10 minutes after the opening of the coronary artery. The changes of St segment and R wave amplitude of ECG were measured 10 minutes after the operation. The above monitoring indexes in each group and between the two groups were statistically analyzed and the differences were compared. Results the baseline indexes of the two groups were compared. That is, age, There was no significant difference in the amplitude of St segment elevation and the corrected number of TIMI frames immediately after the opening of infarct-associated artery 5 minutes before the opening of infarct-related artery. There was no significant difference between the control group and the control group. In the control group, St segment lifting was 5 minutes and 10 minutes immediately after the opening of the infarct-related artery. The R wave amplitudes of 0.3320 鹵0.06888 mvnvn were 1.4010 鹵0.19525 鹵0.19525mvn, 1.3720 鹵0.18582mv.There was no significant difference between the two groups. The corrected TIMI frame number within 10 minutes after the opening of infarct related artery was 2630.25 鹵5.6284444) frame, respectively, and 29.5500 鹵5.79434) frames were corrected for 10 minutes after the opening of infarct related artery, and the values of RV wave were 0.3580 鹵0.06354mVV, 0.3343 鹵0.06827mVN 0.3320 鹵0.06828444.The amplitudes of R wave were 1.4010 鹵0.19525mvn 鹵1.3720 鹵0.18582mv.There was no significant difference in the number of TIMI frames corrected for 10 minutes after the opening of infarct related artery. The results indicated that there was significant difference between the baseline and the infarction related artery at 5 minutes and 10 minutes after the opening, but there was no significant difference between the experimental group and the experimental group in 5 minutes after the opening of the infarct related artery and 10 minutes after the opening of the infarct related artery. 3 in the trial group, there was no significant difference in the opening of the infarct related artery. The ST-segment elevation values were 0.3522 鹵0.06233mvl 0.3203 鹵0.06538mvl 0.2695 鹵0.07531mv at 5 minutes and 10 minutes after opening respectively, indicating that there was no significant difference between immediately after opening and baseline (P 0.05), 10 minutes after opening compared with baseline and immediately after opening, there was statistical significance (P 0.05), and 10 minutes after opening had statistical significance compared with baseline and immediately after opening. The amplitudes of P0.05U, R wave were 1.3875 鹵0.18403mvlv, 1.3838 鹵0.18422mvmv1. 3810 鹵0.18282mv, respectively. The corrected TIMI frames were 27.1125 鹵4.72512) frames and 24.4125 鹵5.00242frames, respectively, 5 minutes after the operation of infarct-related artery, and there was no significant difference in P0.05mv between 5 minutes and 5 minutes after the operation of the infarct-related artery, the amplitude of R wave was 1.3875 鹵0.18403mvlv, respectively, and there was no significant difference between the two groups. The corrected TIMI frames were 27.1125 鹵4.72512) frames. It was suggested that there was significant difference between the baseline and the baseline at 5 minutes after the opening, and there was still a significant difference between the five minutes after the opening and the 10 minutes after the opening of the operation compared with the baseline, and there was still a significant difference between the two groups, and there was no significant difference between the two groups. ST-segment elevation in the control group and the experimental group was statistically significant 10 minutes after the opening of the infarct-related artery, but no statistical significance was found in the other time periods. There was no statistical significance in the comparison of the amplitude of the R wave in the control group and the experimental group in different time periods, and there was no significant difference in the correlation between the two groups. There were significant differences in the number of TIMI frames at 5 minutes and 10 minutes after opening. Conclusion: 1 Salvia miltiorrhiza polyphenolic acid can effectively inhibit myocardial ischemia-reperfusion injury. The effect time was early and the gain increased with the increase of time. 2 Salvia miltiorrhiza polyphenolic acid could improve coronary microcirculation perfusion.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R542.22

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