本文選題：ST段抬高型急性心肌梗死　切入點：炎癥反應(yīng)　出處：《河南中醫(yī)學(xué)院》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:觀察血塞通注射液對急性ST段抬高型心肌梗死患者PCI術(shù)后炎癥反應(yīng)及心功能的影響。方法收集2013年2月-2015年3月入住河南中醫(yī)學(xué)院第一附屬醫(yī)院被確診為急性ST段抬高型心肌梗死、中醫(yī)診斷符合血瘀證、急診行PCI術(shù)治療的患者。共納入70例,術(shù)前隨機分為觀察組34人,對照組36人。兩組患者均按照最新PCI治療指南常規(guī)進行,兩組患者術(shù)前常規(guī)均阿司匹林300mg嚼服,氯吡格雷600mg口服;試驗組術(shù)前給予血塞通注射液靜脈推注400mg,并于術(shù)后連續(xù)靜脈滴注,血塞通400mg+GS/NS250ml,每天1次,連續(xù)使用14天;對照組給予等量的安慰劑。對比分析兩組患者術(shù)前及術(shù)后15天的超敏C反應(yīng)蛋白(Hs CRP)、五聚蛋白3(PTX-3)、腦鈉肽(BNP)水平的差異性及術(shù)前、術(shù)后24h心肌酶(CK-MB)、超敏肌鈣蛋白(c Tn T)的水平變化,以及術(shù)后即刻和1月后的心臟左室射血分數(shù)(LVEF)及左室舒張末內(nèi)經(jīng)(LVEDd)的差異性,血瘀證評分的變化情況。結(jié)果:1、兩組基線的比較兩組患者的基線資料包括性別、年齡、高血壓病史、糖尿病病史、血脂代謝異常病史、心梗病史、心梗部位、累計病變等均無統(tǒng)計學(xué)差異(P0.05)。2、炎癥指標的變化兩組患者治療前的血清Hs CRP、PTX-3水平比較,差異無統(tǒng)計學(xué)意義(P0.05);治療后兩組患者血清Hs CRP、PTX-3均降低,但對照組治療前后差異無統(tǒng)計學(xué)意義(P0.05)。試驗組治療后比對照組顯著降低,差異均有統(tǒng)計學(xué)意義[Hs CRP:(2.48±1.76)比(5.12±1.54)mg/L,t=3.264,P=0.024;PTX-3:(4.8±1.3)比(7.2±2.3)ng/ml,t=3.526,P=0.01].3、心肌損傷標記物的變化兩組患者術(shù)前CK-MB和c Tn T水平的比較,差異無統(tǒng)計學(xué)意義(P0.05);術(shù)后24h兩組患者的CK-MB和c Tn T水平均較前降低,且試驗組比對照組降低的更明顯,差異有統(tǒng)計學(xué)意義[CK-MB:(62.4±12.3)比(142.6±36.4)U/L,t=4.231,P=0.016;c Tn T:(12.5±3.6)比(34.8±7.2)μg/L,t=3.957,P=0.014]。4、BNP評價結(jié)果兩組患者入院即刻BNP水平比較,差異無統(tǒng)計學(xué)意義(P0.05);術(shù)后15天兩組患者BNP水平均明顯下降,且試驗組比對照組降低的更明顯,差異有統(tǒng)計學(xué)意義[(153±122)比(249±191)pg/ml,t=3.426,P=0.026].5、心臟彩超兩組患者術(shù)后即刻行心臟彩超LVDd及EF水平的比較,差異均無統(tǒng)計學(xué)意義(P0.05);術(shù)后15天和30天的LVDd水平較前明顯降低,EF水平較前明顯升高,且隨著時間延長,改善更明顯,組內(nèi)比較均有統(tǒng)計學(xué)意義(P0.05)。兩組患者術(shù)后15天的LVDd及EF水平的比較,差異均無統(tǒng)計學(xué)意義(P0.05);而術(shù)后30天試驗組的LVDd水平較對照組更加降低,EF水平更加升高,差異均有統(tǒng)計學(xué)意義[LVDd:(53.6±4.8)比(54.7±3.9)mm,t=1.925,P=0.041;EF:(50.3±4.1)比(49.6±3.8)%,t=1.892,P=0.043].6、患者血瘀證評分比較兩組患者術(shù)前血瘀證評分的比較,差異無統(tǒng)計學(xué)意義(P0.05);術(shù)后15天兩組患者血瘀證評分均明顯下降,且試驗組比對照組降低的更明顯,差異有統(tǒng)計學(xué)意義[(28.6±10.1)比(34.1±11.2)分,t=2.856,P=0.039].結(jié)論:血塞通注射液能夠降低急性ST段抬高型心肌梗死患者的炎癥反應(yīng),改善患者心功能,降低血瘀證積分。
[Abstract]:Objective: To observe the effect of Xuesaitong Injection on inflammatory response and cardiac function in patients with acute ST segment elevation myocardial infarction patients after PCI. Methods from February 2013 -2015 year in March in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine was diagnosed with acute ST elevation myocardial infarction, TCM diagnosis of blood stasis syndrome, the emergency patients received PCI therapy were included. 70 cases before operation were randomly divided into observation group of 34 people, 36 people in the control group. Two patients were in accordance with the new guidelines for the treatment of conventional PCI, two groups of patients before routine were chewing aspirin 300mg, clopidogrel 600mg oral test group; preoperative Administration of Xuesaitong injection intravenous injection of 400mg, and in operation after continuous intravenous injection, Xuesaitong injection 400mg+GS/NS250ml, 1 times a day, 14 days of continuous use; the control group given placebo. Analysis of high sensitive C reactive protein in 15 days of the two groups of patients before and after contrast (Hs CRP), five poly Protein 3 (PTX-3), brain natriuretic peptide (BNP) and the level of difference operation, postoperative myocardial enzyme 24h (CK-MB), high-sensitivity troponin (C Tn T) level changes, and immediately after operation and in January after the left ventricular ejection fraction (LVEF) and left ventricular end diastolic period the difference (LVEDd), changes of blood stasis score. Results: 1, the two groups at baseline were compared between two groups of baseline data including gender, age, history of hypertension, history of diabetes, history, abnormal lipid metabolism, myocardial infarction, infarct location, total lesions were not statistically significant (P0.05.2). Serum Hs CRP changes of inflammatory index of patients in two groups before treatment, the level of PTX-3, the difference was not statistically significant (P0.05); the two groups after treatment of serum Hs in patients with CRP, PTX-3 decreased, but the control group before and after treatment the difference was not statistically significant (P0.05). The test group after treatment significantly lower than control group, the differences were statistical significance 涔塠Hs CRP:(2.48鹵1.76)姣，

本文編號：1642777