胺碘酮对心肌缺血-再灌注损伤保护作用的研究(1)
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[摘要] 目的:探讨胺碘酮(AM)对ST段抬高性急性心肌梗死(STEAMI)溶栓术后心肌缺血-再灌注损伤(MI/RI)的保护作用。方法:80例STEAMI溶栓患者随机分为A组(AM组,40例)和B组(对照组,40例),观察两组患者再灌注心律失常、二重乘积(SBP×HR)、CK-MB、cTnT、SOD、MDA的变化。结果:溶栓术后A组较B组再灌注心律失常明显减少,CK-MB、cTnT活性显著降低,MDA含量明显降低,SOD活性明显增高,差异有统计学意义(P<0.05);SBP×HR差异无统计学意义(P>0.05)。结论:应用AM对STEAMI溶栓患者MI/RI具有保护作用。
[关键词] 胺碘酮;再灌注心律失常;SBP×HR;CK-MB;cTnT;MDA;SOD
[中图分类号] R541.4[文献标识码]A [文章编号]1673-7210(2010)05(a)-017-03
Study of Amiodarone on protection of myocardial ischemical reperfusion injury
LIU Jianxiu, HU Huayuan, XIE Bingdi
(Department of Cardiology, Huidong County People's Hospital, Huidong 516300, China)
[Abstract] Objective: To investigate the protection of Amiodarone on myocardial ischemical reperfusion injury (MI/RI) of patients after thrombolysis of STEAMI. Methods: 80 patients with STEAMI, who were received thrombolysis, were randomly divided into two groups. Group A had 40 patients, were given Amiodarone; group B had 40 patients, were not given Amiodarone. The indexes of reperfusion arrhythmia, SBP×HR, CK-MB, cTnT, MDA and SOD of MI/RI in both groups were observed. Results: Compared with group B after thrombolysis, the reperfusion arrhythmia of group A was decreased, the activities of CK-MB and cTnT were decreased, MDA level was decreased, and the activity of SOD was increased, they showed statistical significance (P<0.05); SBP×HR showed no statistical significance between the two groups (P>0.05). Conclusion: Amiodarone can relieve MI/RI on patients with STEAMI after thrombolysis.
[Key words] Amiodarone; Reperfusion arrhythmia; SBP×HR; CK-MB; cTnT; MDA; SOD
冠心病是常见的心血管疾病,ST段抬高性急性心肌梗死(STEAMI)是最严重的临床表现之一,再灌注治疗是关键。再灌注治疗以经皮静脉溶栓术、经皮冠状动脉介入术(PCI)和冠状动脉搭桥术(CABG)三种最为常见。当前,虽然急诊PCI广泛应用于临床,但是对于基层医院,尤其是偏远山区,由于设备、经济原因等因素,再灌注仍然以经皮静脉溶栓术为主。再灌注会出现钙超载、氧自由基产生及细胞的黏附与聚集等再灌注损伤的病理生理改变。因此,在溶栓过程中可能出现再灌注心律失常、无复流现象、心肌顿抑、炎症介质反应、心肌代谢改变等缺血-再灌注损伤(MI/RI)表现。本文通过分析我院80例STEAMI患者的一般资料,研究溶栓前应用胺碘酮(AM)对MI/RI的影响。
1 资料与方法
1.1 病例选择与分组
按照中华医学会2001年颁布的AMI诊断标准[1],收集2008年7月～2009年9月起病12 h内收入院即行静脉溶栓术的STEAMI患者80例,并随机分为两组:A组(AM组)入院后即给予静脉应用AM(商品名可达龙,法国赛诺菲公司生产,批号J20030022,每支含AM 150 mg),具体用法为:术前先静脉注射AM负荷量150 mg,随后给予维持量1 mg/(kg·h),并依据病情变化适当调节用药时间;B组(对照组)急诊溶栓术前未预防性应用AM ......
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