| Objective:Percutaneous coronary intervention(PCI) is a main treatment of acute myocardial infarction(AMI) . PCI can recanalizate the vascellum,but can not satisfy the reperfusion and patency of capillary vessel.The constitution and function of capillary vessel frustrate since the reperfusion of ischemia area is not sufficient. How to improve the reperfusion of ischemia cardiac muscle become a hot issue.Composite danshen dropping pill is made of salvia miltiorrhiza , panax pseudo-ginseng and borneol .Studies found that CDDP can dilate coronary artery,increase cornary flow,prevent myocardial ischema,preserve blood vessal endotheliu , antiplatelet aggregation and etc.The role of CDDP to effect myocardial reperfusion of acute coronary syndrome (ACS) patients after PCI is seldom reported,which caused the concern of scholars at home and abroad for a long time.The aim of this experiment is to explore the effection of CDDP on myocardial reperfusion in ACS patients after PCI by MCE.Method:Selected patients were parallelismly divided into AMI direct PCI group; AMI elective PCI group;unstable angina PCI group.Each group was randomly divided into CDDP-therapy group and control group. While patiens in therapy group agreed to get PCI,CDDP are peroral administrated through gavage for at least two month.We observe the myocardial reperfusion by myocardial contrast echocardiography (MCE),determine the appear time(AT),the appear to peak time(APT),the peak intensity(PI), the amplitude(A); plot ascensus slope rate(β) and A×βof myocardial infarction and un-infarction/ischemia and un-ischemia area.The analysis of these data can reflet the blood flow rate and volume.Results:The results of CDDP group compared with control group in AMI direct PCI group,AMI elected PCI group and UA PCI group:the appear time and the appear to peak time are significantly reduced(P<0.05). The peak intensity,A and A×βare significantly increased(P<0.05).Discussion:Reperfusion is an important method to save myocardium after AMI.The recanalization of cornary vessel is not equal to the open of microvascular and the good reperfusion of myocardial.The microcirculation disturbrance of AMI included abnormal of the blood rheologyand ischemia reperfusion injury.The ischemia reperfusion can break cornory artery microcirculation by infiltrating neutrophil ,releasing oxygen radicle,and increasing Ca2+ in myocardial, activating complement and adhesion molecule and the endothelium trauma. Ischemia reperfusion trauma can induce the myocardial loss.Programmed cell death may cause the myocardial loss. The reason and mechanism of no re-flow after PCI is not so clear. The piece,microthrombus and platelet formed by atheromatous plaque induce to the embolism of distal end capillary vessel.Sacculus proprius or bracket tear vessel wall and perfusion pressure suddenly increased after revascularization induce to capillary vessel angiospasm and ischemia-reperfusion trauma.Ischemia induce to capillary vessel disorganization and myocardial hydrops compress capillary vessel.The microcirculation disturbrance of UA included abnormal of the blood rheology,instability plaque,inflammatory factor release and endothelium function disturbance.The experimental results reflect that CDDP can be effective in improving myocardial reperfusion in patients after PCI.The mechanism of CDDP improving myocardial reperfusion in acute myocardial infarction patients with PCI as follow:1.CDDP can lessen reperfusion injury:inhibit calcium influx,anti-lipid peroxidation,depress oxyradical to injury blood vessel endothelium,palliate reperfusion injury,degrade myocardial comsumption of oxygen.2. CDDP can improve blood rheology index: degrade blood viscosity,inhibit platelet activation,improve microcirculat ion ,adjust vasomotion factor,dilate coronary artery,degrade erythrocyte aggregation,improve erythrod-egenration.3. CDDP can protect myocardium and endothelium.The mechanism of CDDP improving myocardial reperfusion in unstable angina patients with PCI may be 1.improve blood rheology index,2.inhibiting inflammatory reaction,3.protecting blood vessel endothelium,4.inhibt the ET-1gene expression in endothelial cell .5.increase myocardial ischemic preconditioningConclusion:CDDP have a strong effect on increasing the myocardial blood flow and redusing the micro circumfusion time . CDDP can be effective in improving myocardial reperfusion in ACS patients after PCI.
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