發(fā)布時間：2018-05-19 00:35

  本文選題：新活素 + 急性前壁心肌梗死��； 參考：《大連醫(yī)科大學》2014年碩士論文

【摘要】：目的：探討急診經(jīng)皮冠脈介入治療（percutaneous coronaryintervertion，PCI）術前血清N-末端腦鈉肽前體（NT-proBNP）水平與急性前壁心梗（acute anterior wall myocardial infarction）患者術后發(fā)生對比劑腎�。╟ontrast induced nephropathy，CIN）的相關性；觀察術后立即應用凍干重組人腦利鈉肽（新活素，rhBNP）持續(xù)靜脈滴注24小時對腎功能的影響。方法：隨機入選60例在遼寧省人民醫(yī)院心內(nèi)科同意接受急診PCI術治療的急性前壁心肌梗死患者，術前均給予阿司匹林腸溶片300毫克、波立維600毫克常規(guī)頓服，非離子型低滲造影劑碘普羅胺(優(yōu)維顯)均在術中應用，血清肌酐(Scr)標準衡量腎功能水平。將60例研究對象隨機分為兩組：a.對照組（30例）：予以阿司匹林腸溶片、波立維、β受體阻斷劑、他汀類藥物、血管緊張素受體阻斷劑（ARB）或血管緊張素轉(zhuǎn)換酶抑制劑(ACEI)等術后常規(guī)治療；b.新活素組（30例）：除應用上述術后常規(guī)藥物治療外，先以90秒勻速靜脈注射負荷劑量1．5μg/kg·min，其后24小時以0．0075μg/kg·min的速率勻速靜脈泵入；分別了解兩組術前血清Scr、NT-proBNP水平，術后24小時、48小時、72小時血清Scr水平。結(jié)果：1.隨機入選60例急性前壁心肌梗死、同意接受急診PCI術治療的患者中，對照組男性18例、女性12例，新活素組男性23例、女性7例，平均年齡為(60.28±13.03)歲，對照組患者的年齡、性別、糖尿病、高血壓、高血脂、心力衰竭（LVEF40%）、慢性腎臟病、吸煙、造影劑劑量水平與新活素組相比較均無明顯差異（P0.05）；2.兩組CIN發(fā)生率：對照組CIN8例，發(fā)生率為26.67%，，新活素組CIN1例，發(fā)生率為3.45%，新活素組CIN發(fā)生率比對照組要低，差別具有統(tǒng)計學意義(P0.05)；3.兩組術前血清Scr、NT-proBNP水平及術后24小時血清Scr水平均無明顯差異性（P㧐0.05），新活素組術后48小時及72小時血清Scr水平比對照組的顯著減少，差別具有統(tǒng)計學意義（P0.05）；4.術前血清NT-proBNP水平與CIN的發(fā)生成正相關，對照組發(fā)生CIN的風險隨血清NT-ProBNP水平的增加有增加趨勢。結(jié)論：急診PCI術前血清NT-proBNP水平可能是預測出急性前壁心�；颊甙l(fā)生CIN的早期生物標記物之一，且可成為早期篩查CIN人群的手段，提高對CIN的防范意識；新活素可保護腎功能、有效改善或預防急診PCI術后急性腎功能不全，降低CIN的發(fā)生率，其應用為臨床防治CIN提供了更多的藥物選擇。
[Abstract]:Objective: to investigate the correlation between the serum NT-proBNPs before percutaneous coronary intervention (PCI) and the incidence of contrast induced nephropathy (cin) in patients with acute anterior wall infarction (AMI). The effects of freeze-dried recombinant human brain natriuretic peptide (rhBNP) on renal function were observed immediately after operation. Methods: sixty patients with acute anterior myocardial infarction (AMI) who accepted emergency PCI operation in Department of Cardiology, Liaoning Provincial people's Hospital were randomly selected. All patients were given aspirin enteric-coated tablets (300mg) and Polivir (600mg) for routine administration before operation. Non-ionic hypotonic contrast agent iopramide was used during operation and serum creatinine Scrs was used to measure renal function. 60 subjects were randomly divided into two groups: a. The control group (n = 30) was treated with aspirin enteric-coated tablets, Borivir, 尾 -blockers, statins, angiotensin receptor blockers (ARB) or angiotensin converting enzyme inhibitor (ACEI). 30 patients in the neovasin group were treated with the above routine drugs, the loading dose was injected intravenously for 90 seconds at a dose of 1.5 渭 g/kg, and then pumped into the vein at a rate of 0.0075 渭 g/kg min at 24 hours after the operation, and the serum levels of Scrn NT-proBNP in the two groups were determined. The serum Scr level was 24 hours, 48 hours and 72 hours after operation. The result is 1: 1. 60 patients with acute anterior myocardial infarction (AMI) were randomly selected. The control group consisted of 18 males, 12 females, 23 males and 7 females, with an average age of 60.28 鹵13.03 years. The age and sex of the patients in the control group were compared with those in the control group (n = 18), female (n = 12), neovasin group (n = 23) and female (n = 7). Diabetes, hypertension, hyperlipidemia, heart failure LVEF40, chronic kidney disease, smoking, contrast agent dose levels compared with the new live hormone group, there was no significant difference (P 0.05). The incidence of CIN in the two groups was 26.67 in the control group and 3.45 in the neovasin group. The incidence of CIN in the neovasin group was lower than that in the control group, and the difference was statistically significant (P 0.05). There was no significant difference in the levels of serum Scrn NT-proBNP and serum Scr 24 hours after operation between the two groups. The serum Scr levels in the neovasin group at 48 hours and 72 hours after operation were significantly lower than those in the control group, and the difference was statistically significant. Preoperative serum NT-proBNP level was positively correlated with the occurrence of CIN, and the risk of CIN in the control group tended to increase with the increase of serum NT-ProBNP level. Conclusion: the serum NT-proBNP level before emergency PCI may be one of the early biomarkers for predicting the occurrence of CIN in patients with acute anterior myocardial infarction, and it can be used as an early method to screen CIN population and raise the awareness of prevention of CIN, while neovasin can protect renal function. It can effectively improve or prevent acute renal insufficiency and reduce the incidence of CIN after emergency PCI, which provides more drug choice for clinical prevention and treatment of CIN.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R542.22

【參考文獻】

相關期刊論文 前1條

1 吉俊;丁小強;許迅輝;鄒建洲;何建強;林貽梅;柏瑾;錢菊英;;低滲非離子造影劑對冠狀動脈介入診療術患者腎功能影響的前瞻性研究[J];中華腎臟病雜志;2006年07期

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