發(fā)布時(shí)間：2018-05-08 06:26

  本文選題：經(jīng)皮冠脈介入治療術(shù) + 曲美他嗪��； 參考：《延安大學(xué)》2014年碩士論文

【摘要】：背景經(jīng)皮冠狀動(dòng)脈介入治療術(shù)(percutaneous coronary intervention，PCI)是治療急性心肌梗死（acute myocardial infarction，AMI）患者當(dāng)前最為直接有效的治療方法，它可以及時(shí)恢復(fù)梗死相關(guān)冠狀動(dòng)脈的血流灌注，挽救受損或?yàn)l臨壞死的心肌細(xì)胞，縮少梗死面積和恢復(fù)心臟功能，改善患者的遠(yuǎn)期預(yù)后，提高生活質(zhì)量。但某些患者并未從中受益，術(shù)后的心肌損傷和不良心血管事件仍較常見，這考慮與PCI術(shù)后心肌微循環(huán)障礙所致的心肌缺血損傷緊密相關(guān)。本研究旨在PCI術(shù)前及術(shù)后給予改善心肌能量代謝的藥物干預(yù)，從而改善心肌微循環(huán)灌注，減少缺血心肌的損傷和術(shù)后不良心血管事件的發(fā)生，最終改善患者的臨床預(yù)后。 目的對(duì)AMI患者行PCI術(shù)前30min口服曲美他嗪（trimetazidine，TMZ）負(fù)荷劑量60mg，術(shù)后長期服用TMZ（20mg，tid），通過觀察PCI術(shù)中冠脈TIMI血流分級(jí)及靶血管無復(fù)流現(xiàn)象（no-reflow phenomenon，NR)的發(fā)生，PCI前后血清肌鈣蛋白I (cardiac troponin I，cTnI)、高敏C反應(yīng)蛋白(high sensitive C-reactive protein，hs-CRP)、左室射血分?jǐn)?shù)（left ventricular ejection fraction，LVEF）和左室短軸縮短率(left ventricular fraction shortening，LVFS)的變化，并通過電話隨訪觀察PCI術(shù)后再發(fā)心絞痛癥狀和主要不良心臟事件（MajorAdverse Cardiovascular Events，MACE，包括再入院、心肌梗死、死亡等），從而探討TMZ對(duì)PCI術(shù)后心肌缺血損傷的影響和可能的作用機(jī)制。 方法選擇我科2013年10月至2014年1月期間擇期行PCI治療的AMI患者35例，其中男性24例，女性11例。采用平行對(duì)照研究，所入選的病例被隨機(jī)分成2組：TMZ組和對(duì)照組。TMZ組18例，對(duì)照組17例。對(duì)照組僅接受常規(guī)治療；而TMZ組除接受常規(guī)治療外，于術(shù)前30min口服TMZ負(fù)荷劑量60mg，術(shù)后長期服用TMZ（20mg，tid）治療。兩組均采用相同的常規(guī)治療如抗血小板聚集、抗凝、β-受體阻滯劑、ACEI類、降脂、硝酸酯類等常規(guī)藥物。觀察并記錄術(shù)中TIMI血流分級(jí)及NR的發(fā)生，并分別測定PCI術(shù)前后cTnI、hs-CRP水平，于PCI前后行心臟超聲檢查，測定LVEF和LVFS。并通過電話隨訪并記錄兩組患者PCI后3月再發(fā)心絞痛及MACE發(fā)生率。 結(jié)果cTnI水平測定示：TMZ組與對(duì)照組患者在PCI術(shù)前無明顯差異且P0.05；PCI術(shù)后24h、48h，兩組患者較術(shù)前均明顯升高（P0.05），但對(duì)照組cTnI水平明顯高于TMZ組（P0.05）。hs-CRP濃度測定示：TMZ組與對(duì)照組患者在PCI術(shù)前無顯著性差異且P0.05；PCI術(shù)后48h，兩組患者較PCI術(shù)前均明顯升高（P0.05），但對(duì)照組hs-CRP明顯高于TMZ組（P0.05）。冠脈TIMI血流分級(jí)及NR示：TMZ組患者PCI術(shù)中Ⅲ級(jí)血流的比例較對(duì)照組高，但無顯著性差異（P0.05）；TMZ組患者NR的發(fā)生率低于對(duì)照組，兩組比較亦無顯著性差異（P0.05）。心臟超聲測定示：TMZ組患者術(shù)后3月LVEF和LVFS均較PCI術(shù)前升高（P0.05）；而對(duì)照組未顯示出顯著性差異（P0.05），術(shù)后TMZ組LVEF和LVFS值均高于對(duì)照組(P0.05)。PCI術(shù)后平均隨訪觀察3個(gè)月后示：TMZ組同對(duì)照組患者比較，再發(fā)心絞痛患者的比例明顯減少（P0.05），TMZ組患者的MACE發(fā)生率低于對(duì)照組，但無顯著性差異（P0.05）。 結(jié)論1.對(duì)于行PCI治療的AMI患者，TMZ可降低術(shù)后cTnI及hs-CRP升高的幅度，改善冠脈血流情況，使患者LVEF和LVFS值升高，提示TMZ可減輕PCI術(shù)后的炎性反應(yīng)，減輕氧自由基引起的脂質(zhì)過氧化引發(fā)的缺血心肌損傷，并可能具有改善心肌微循環(huán)及提高左心功能的作用，為PCI術(shù)后患者提供心肌保護(hù)。2.術(shù)后長期服用TMZ則可通過改善心肌細(xì)胞代謝等方式，明顯降低PCI術(shù)后患者再發(fā)心絞痛癥狀及比率，改善患者的遠(yuǎn)期預(yù)后，提高PCI術(shù)后患者生活質(zhì)量。
[Abstract]:Background percutaneous coronary intervention (percutaneous coronary intervention, PCI) is the most direct and effective treatment for patients with acute myocardial infarction (acute myocardial infarction, AMI). It can restore the infarct related coronary artery blood perfusion in time to save the damaged or near necrotic myocardial cells and reduce the infarction. The dead area and the recovery of heart function improve the long-term prognosis and improve the quality of life. However, some patients have not benefited from it. Myocardial injury and adverse cardiovascular events are still more common after the operation, which is closely related to myocardial ischemia injury caused by myocardial microcirculation after PCI. This study aims to improve the pre and post operation of PCI. Drug intervention of myocardial energy metabolism improves myocardial microcirculation perfusion, reduces ischemic myocardium injury and postoperative adverse cardiovascular events, and ultimately improves the patient's clinical prognosis.
Objective to perform 30min (trimetazidine, TMZ) loading dose 60mg before PCI for AMI patients, and to take TMZ (20mg, TID) for a long time after operation, and to observe the incidence of TIMI blood flow in the operation of the coronary artery and the occurrence of no reflow of the target vessels in PCI. High sensitive C-reactive protein (hs-CRP), the left ventricular ejection fraction (left ventricular ejection fraction, LVEF), and the short axis shortening of the left ventricle (left ventricular) were observed and followed up by telephone follow-up to observe the symptoms of angina and the major adverse cardiac events TS, MACE, including readmission, myocardial infarction, death, etc., to explore the effect of TMZ on myocardial ischemic injury after PCI and the possible mechanism.
Methods 35 patients with AMI from October 2013 to January 2014, including 24 male and 11 female, were randomly divided into 2 groups: group TMZ and control group, group.TMZ 18, control group 17. The control group received routine treatment, and the TMZ group received routine treatment, and the TMZ group was treated with routine treatment, in the TMZ group in addition to conventional treatment, in the TMZ group, in addition to conventional treatment, in the control group. Preoperative 30min oral TMZ load dose 60mg, long-term use of TMZ (20mg, TID) treatment. The two groups of the same routine treatment such as anti platelet aggregation, anticoagulant, beta blocker, ACEI class, lipid lowering, nitrate and other conventional drugs. Observe and record the incidence of TIMI blood flow grade and NR, and determine the cTnI, hs-CRP level before and after PCI, respectively. Echocardiography was performed before and after PCI, LVEF and LVFS. were measured, and the incidence of recurrent angina pectoris and MACE in two groups of patients after March were recorded by telephone follow-up and PCI.
Results the cTnI level showed that there was no significant difference between the TMZ group and the control group before PCI and P0.05; after PCI, 24h, 48h, and two groups were significantly higher than before operation (P0.05), but the level of cTnI in the control group was significantly higher than that in the TMZ group (P0.05). H, the two groups were significantly higher than the preoperative PCI (P0.05), but the control group was significantly higher than the TMZ group (P0.05). The coronary TIMI flow classification and NR showed that the proportion of grade III blood flow in the TMZ group was higher than the control group, but there was no significant difference (P0.05), and the incidence rate of the TMZ group was lower than that of the control group, and there was no significant difference between the two groups. Echocardiography showed that in group TMZ, LVEF and LVFS were higher in March than before PCI (P0.05), but there was no significant difference in the control group (P0.05). The LVEF and LVFS values in the TMZ group were higher than those of the control group (P0.05).PCI after 3 months after operation: the TMZ group was compared with the control group and the proportion of the patients with recurrent angina pectoris was obvious. Decrease (P0.05), the incidence of MACE in group TMZ was lower than that in control group, but there was no significant difference (P0.05).
Conclusion 1. for AMI patients treated with PCI, TMZ can reduce the elevation of cTnI and hs-CRP after operation, improve the blood flow of coronary artery and increase the value of LVEF and LVFS, suggesting that TMZ can reduce the inflammatory response after PCI operation, reduce the myocardial injury caused by lipid peroxidation induced by oxygen free radicals, and may improve myocardial microcirculation and improve the myocardial microcirculation. The function of left heart function, for patients after PCI, the long-term use of TMZ after the operation of myocardial protection.2. can improve the symptom and rate of re angina after PCI, improve the long-term prognosis of patients and improve the quality of life after PCI.

【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R542.22

【參考文獻(xiàn)】

相關(guān)期刊論文 前7條

1 韋德宇;丁曉梅;蘇浩;胡昊;陳東;;IL-17、hs-CRP聯(lián)合檢測在急性冠脈綜合征中的意義[J];安徽醫(yī)藥;2011年03期

2 王穎波;陳立萍;史偉濤;李懷東;張立新;;曲美他嗪對(duì)老年冠心病多支病變患者的治療效果分析[J];中國醫(yī)藥導(dǎo)刊;2011年05期

3 楊樹森;甘潤韜;孫延明;王政;董國;潘薇;;阿托伐他汀對(duì)ST段抬高型急性心肌梗死患者急診PCI術(shù)后無復(fù)流現(xiàn)象的影響[J];臨床心血管病雜志;2011年01期

4 劉偉;;抽吸導(dǎo)管在急診經(jīng)皮冠狀動(dòng)脈介入術(shù)中的臨床應(yīng)用研究[J];醫(yī)學(xué)綜述;2012年17期

5 陳清杰;楊毅寧;馬依彤;李曉梅;謝翔;于子翔;郭海;;尼可地爾對(duì)急性心肌梗死再灌注療效的Meta分析[J];中國循證醫(yī)學(xué)雜志;2012年11期

6 喬亞京;逯保軍;張素清;;曲美他嗪對(duì)急性心肌梗死患者介入治療術(shù)后心肌的保護(hù)作用[J];中國現(xiàn)代醫(yī)藥雜志;2012年11期

7 趙樹武;馬洪俊;王媛媛;王玉平;吳英鳳;劉長紅;王玉昆;劉革明;桂正光;李振龍;曹景麗;張杰;劉毅;許承斌;李玉花;;急性冠狀動(dòng)脈綜合征患者經(jīng)皮冠狀動(dòng)脈介入治療成形術(shù)中血栓抽吸對(duì)術(shù)后1年心臟事件的影響[J];中國心血管雜志;2013年01期

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