【摘要】：目的：驗證重組人腦利鈉肽（新活素）對急性前壁心肌梗死患者急診介入術后近期預后的影響。 方法：選取2012年3月至2013年3月就診于遼寧省人民醫(yī)院的30例因急性前壁心肌梗死Killip I-III級，行急診介入術的患者。隨機將患者分為重組人腦利鈉肽（新活素）組共18例，此為治療組，余12例為對照組。兩組患者在突發(fā)急性前壁心肌梗死后，均予急診冠脈介入術。術前記錄患者血壓、實驗室指標、18導聯(lián)心電圖，予治療組依體重負荷量新活素靜推。再經(jīng)橈動脈或股動脈穿刺后行冠脈介入術。術后常規(guī)予低分子肝素、抗凝藥等藥物治療，，必要時予替羅非班、β-受體阻滯劑、利尿劑、地高辛、西地蘭等維持治療。治療過程中酌情加入洋地黃、多巴胺、多巴酚丁胺或米力農(nóng)等正性肌力藥，治療組在常規(guī)藥物基礎上依照體重計算出新活素用量靜脈勻速泵入并維持72小時。此次新活素為深圳康哲藥業(yè)公司生產(chǎn)。分別記錄兩組介入術后生命體征、胸痛緩解程度、生化指標、心臟彩超的變化。記錄術后24小時尿量，記錄治療后1周SV、LAD、左室短軸縮短率、 LVD及LVEF,于入院即刻及治療后第七天，分別測得BNP值，記錄患者1月內(nèi)發(fā)生的心臟不良事件，采用spass17.0軟件進行統(tǒng)計學分析。 結果：1.rh-BNP組和對照組患者胸痛均有不同程度的緩解，差異沒有統(tǒng)計學意義（P0.05）。 2. rh-BNP組和對照組患者收縮壓和舒張壓均有下降，但差異沒有統(tǒng)計學意義（P0.05）。 3. rh-BNP組和對照組患者心率改變不明顯。 4.rh-BNP組患者24小時尿量較對照組患者24小時尿量稍多，但差異無統(tǒng)計學意義(P0.05)。 5. rh-BNP組患者的CK-MB峰值和TNT峰值較對照組低，但差異無統(tǒng)計學意義(P0.05)，BNP變化rh-BNP組和對照組無統(tǒng)計學意義(P0.05)。 6.rh-BNP組和對照組患者的血清Scr變化無統(tǒng)計學意義(P0.05)。 7.rh-BNP組和對照組患者SV、左室短軸縮短率及LVEF,LA均無統(tǒng)計學差異(P0.05)，LVD rh-BNP組和對照組具有統(tǒng)計學意義(P0.05)。 8.rh-BNP組發(fā)生不良事件低血鉀1例對照組發(fā)生不良事件患者死亡1例無統(tǒng)計學意義(P0.05)。 結論：1.rh-BNP可能有早期抑制心肌重塑的作用。 2.rh-BNP對患者腎功能血清Scr未見升高，有一定的安全性。
[Abstract]:Aim: to investigate the effect of recombinant human brain natriuretic peptide (NPP) on the short-term prognosis of patients with acute anterior myocardial infarction (AMI) after emergency intervention. Methods: from March 2012 to March 2013, 30 patients with acute anterior myocardial infarction (Killip I-III) received emergency interventional surgery in Liaoning Provincial people's Hospital. The patients were randomly divided into recombinant human brain natriuretic peptide (neo) group (n = 18), treatment group (n = 12) and control group (n = 12). Patients in both groups were treated with emergency coronary intervention after acute anterior myocardial infarction. Blood pressure, laboratory indexes and 18 lead electrocardiogram were recorded before operation. Coronary intervention was performed after transradial or femoral artery puncture. Low molecular weight heparin (LMWH), anticoagulant and so on, and tirofiban, 尾-receptor blocker, diuretic, digoxin, cilandipine, etc. Positive muscle drugs such as digitalis, dopamine, dobutamine or milrinone were added into the treatment process as appropriate. In the treatment group, the dosage of neovasin was uniformly pumped into the vein according to body weight for 72 hours. The new vitality for Shenzhen Kang Zhe Pharmaceutical Co., Ltd. Vital signs, degree of relief of chest pain, biochemical indexes and changes of color Doppler echocardiography were recorded in the two groups. 24 hours urine volume was recorded, left ventricular shortening rate of SV,LAD, was recorded 1 week after treatment, BNP values were measured by LVD and LVEF, at admission and 7 days after treatment, and adverse cardiac events occurred within 1 month were recorded. Spass17.0 software was used for statistical analysis. Results: the chest pain in 1.rh-BNP group and control group were relieved to different degrees, the difference was not statistically significant (P0.05). 2. Systolic blood pressure and diastolic blood pressure were decreased in rh-BNP group and control group, but the difference was not statistically significant (P0.05). 3. There was no significant change in heart rate in rh-BNP group and control group. The 24 hour urine volume in 4.rh-BNP group was slightly higher than that in control group, but there was no significant difference (P0.05). 5. The peak value of CK-MB and TNT in rh-BNP group was lower than that in control group, but the difference was not statistically significant (P0.05). There was no significant difference between rh-BNP group and control group (P0.05). The changes of serum Scr in 6.rh-BNP group and control group were not statistically significant (P0.05). There was no significant difference in left ventricular shortening rate and LVEF,LA between 7.rh-BNP group and control group (P0.05 in), LVD rh-BNP group and control group (P0.05). There was no significant difference in adverse events and hypokalemia in 8.rh-BNP group (P0.05). Conclusion: 1.rh-BNP may have an early inhibitory effect on myocardial remodeling. 2.rh-BNP has no increase in serum Scr in patients with renal function and is safe to some extent.
【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】：2013
【分類號】：R542.22

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