本文關(guān)鍵詞：曲美他嗪對(duì)改善女性冠心病動(dòng)脈僵硬度的研究　出處：《山東大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 曲美他嗪 冠心病 臂踝脈搏波速度 臂踝指數(shù)

【摘要】：目的：本研究通過(guò)對(duì)比女性冠心病患者介入治療前后臂踝脈搏波速度增強(qiáng)指數(shù)和臂踝指數(shù)的變化,明確曲美他嗪(trimetazidine, TMZ)對(duì)兩者的影響,從而進(jìn)一步探討臂踝脈搏波速度和臂踝指數(shù)的影響因素及其與心血管疾病的關(guān)系。研究方法：本研究共納入2013年3月至2014年12月在我院心內(nèi)科行經(jīng)皮冠狀動(dòng)脈介入(Percutaneous intervention, PCI)治療的女性冠心病患者152例,其中年齡為46-81歲,平均年齡為59.45±11.56歲。隨機(jī)分為對(duì)照組(n=76)和曲美他嗪治療組(n=76)。對(duì)照組給予阿司匹林、氯吡格雷、低分子量肝素、硝酸脂類、他汀類、β受體阻滯劑、ACEI類等常規(guī)藥物治療。曲美他嗪組患者在常規(guī)治療的基礎(chǔ)上,在PCI術(shù)前24 h給予20 mg 3/日的治療。治療持續(xù)時(shí)間為90 d。對(duì)所有入選患者的基本資料和病史資料進(jìn)行詳細(xì)的記錄。患者入院后行臨床生化指標(biāo)的檢查,同時(shí)行常規(guī)超聲心動(dòng)圖檢查。在患者進(jìn)行介入治療前及治療后3月采用日本Colin公司生產(chǎn)的動(dòng)脈硬化檢測(cè)儀VP-1000測(cè)定雙側(cè)臂踝脈搏波速度和臂踝指數(shù)的變化。統(tǒng)計(jì)學(xué)分析三種指標(biāo)在治療前后的差異及其影響它們變化的相關(guān)因素。研究結(jié)果：在對(duì)照組患者中,臂踝脈搏波速度在治療前后的差異無(wú)統(tǒng)計(jì)學(xué)意義,臂踝指數(shù)在治療前后的差異亦無(wú)統(tǒng)計(jì)學(xué)意義。在曲美他嗪組患者中,臂踝脈搏波速度由治療前的(1656.96±379.16)cm/s降至治療后的(1556.72±313.18)cm/s,治療前后的差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療后臂踝脈搏波速度顯著改善；臂踝指數(shù)有治療前的1.08±0.15下降至治療后的1.05±0.19,但差異未見統(tǒng)計(jì)學(xué)意義(P0.05)。經(jīng)組間比較,治療前對(duì)照組和曲美他嗪組臂踝脈搏波速度和臂踝指數(shù)的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；治療后,曲美他嗪組臂踝脈搏波速度與對(duì)照組相比出現(xiàn)顯著降低(P0.05),而臂踝指數(shù)上雖有下降,但無(wú)顯著性差異。多元回歸分析顯示,年齡和收縮壓是臂踝脈搏波速度的主要影響因素(r=0.436,P0.01；r=0.587,P0.01),臂踝脈搏波速度與冠脈病變程度呈正相關(guān)(P0.05)。此外,我們的研究發(fā)現(xiàn)患者是否具有糖尿病(P0.05)和空腹血糖(P0.01)是臂踝指數(shù)的危險(xiǎn)因素。結(jié)論：年齡和收縮壓是臂踝脈搏波速度的主要影響因素,臂踝脈搏波速度與冠脈病變支數(shù)呈密切正相關(guān)。糖尿病、脈壓是臂踝指數(shù)的危險(xiǎn)因素。曲美他嗪能對(duì)抗腎上腺素、去甲腎上腺素及血管緊張素胺的縮血管作用,能減低血管阻力,擴(kuò)張冠狀動(dòng)脈,增加冠脈血流量及周圍循環(huán)血流量,促進(jìn)心肌代謝及心肌能量的產(chǎn)生,同時(shí)減低心臟工作負(fù)荷,減低心肌耗氧量及心肌能量的消耗,從而改善心肌氧供平衡明顯降低臂踝脈搏波速度、改善動(dòng)脈僵硬度,并且可能改善胰島素抵抗、抗氧化、改善血管內(nèi)皮功能、減少血管平滑肌增殖,減少脂質(zhì)沉積有關(guān)。
[Abstract]:Objective: to study the changes of brachial ankle pulse wave velocity enhancement index and brachial ankle index in female patients with coronary heart disease before and after interventional therapy to determine trimetazidine. The influence of TMZ on both. So as to further study the influence factors of brachial ankle pulse wave velocity and brachial ankle index and the relationship between brachial ankle pulse wave velocity and cardiovascular disease. This study included percutaneous coronary intervention in our hospital from March 2013 to December 2014. Percutaneous intervention. PCI) was used to treat 152 female patients with coronary heart disease, aged 46-81 years. The average age was 59.45 鹵11.56 years old. They were randomly divided into control group and trimetazidine treatment group. The control group was given aspirin, clopidogrel and low molecular weight heparin. The patients in trimetazidine group were treated with routine drugs, such as nitrate, statins, 尾 -receptor blockers and ACEI. The patients in trimetazidine group were treated on the basis of routine therapy. 20 mg / d was given 24 hours before PCI. The duration of treatment was 90. D. The basic and historical data of all patients were recorded in detail. The clinical biochemical indexes were examined after admission. At the same time, routine echocardiography was performed. Before and after interventional therapy, the pulse wave velocities of bilateral brachial malleolus and brachial pulse wave were measured with VP-1000 instrument produced by Colin Company of Japan on March. Changes in ankle index. Statistical analysis of the differences between the three indexes before and after treatment and related factors affecting their changes. Results:. In the control group. There was no significant difference in brachial ankle pulse wave velocity before and after treatment, and there was no significant difference in brachial ankle index before and after treatment. The pulse wave velocity of brachial ankle decreased from 1656.96 鹵379.16 cm / s before treatment to 1556.72 鹵313.18 cm / s after treatment. The difference before and after treatment was statistically significant (P 0.05), and the pulse wave velocity of brachial malleolus was significantly improved after treatment. The brachiolus index decreased from 1.08 鹵0.15 before treatment to 1.05 鹵0.19 after treatment, but the difference was not statistically significant (P 0.05). There was no significant difference in brachial ankle pulse wave velocity and brachial ankle index between the control group and trimetazidine group before treatment (P 0.05). After treatment, the brachial malleolus pulse wave velocity in trimetazidine group was significantly lower than that in the control group, while the brachial ankle index was decreased, but there was no significant difference. Multiple regression analysis showed. Age and systolic pressure were the main influencing factors of brachial pulse wave velocity. The pulse wave velocity of brachial malleolus was positively correlated with the severity of coronary artery lesion. In addition, there was a positive correlation between the velocity of brachial and ankle pulse wave and the severity of coronary artery lesion. Our study found whether patients had diabetes mellitus (P 0.05) and fasting blood glucose (P 0.01). Conclusion: age and systolic blood pressure are the main influencing factors of brachial ankle pulse wave velocity. The pulse wave velocity of brachial malleolus was positively correlated with the number of coronary artery branches. In diabetes mellitus, pulse pressure was the risk factor of brachial ankle index. Trimetazidine could antagonize the vasoconstriction of epinephrine, norepinephrine and angiotensin amine. It can reduce vascular resistance, dilate coronary artery, increase coronary blood flow and peripheral circulation blood flow, promote myocardial metabolism and myocardial energy production, and reduce cardiac workload. Reduce myocardial oxygen consumption and myocardial energy consumption, thereby improving myocardial oxygen supply balance significantly reduce brachial ankle pulse wave velocity, improve arterial stiffness, and may improve insulin resistance, anti-oxidation. Improving vascular endothelial function, reducing vascular smooth muscle proliferation, reducing lipid deposition.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R541.4

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相關(guān)期刊論文 前1條

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本文編號(hào)：1430564