| Objective:Study of the influence of Panax Notoginsenoside Injectionon picrocirculation of the heart and recent heart function of the patients with STEMI before and after emergency PCI.Methods: 70 patients from 18 to 75 years old with STEMI from First Affiliated Hospital of Henan TCM College were selected between February 2013 to March 2015. There are 38 males and 32 females. Once diagnosed after admission in patients with acute myocardial infarction, and the exclusion of patients with acute left ventricular failure, malignant arrhythmias, cardiogenic shock, severe liver and kidney dysfunction, severe anemia, acute cerebral hemorrhage in patients observed indicators, signing an informed agreement, randomly divided into two groups. Then the blood, blood clots to stop bleeding, biochemistry, BNP(brain natriuretic peptide), TEG is detected immediately on the first and the fifteenth day. Observing the left ventricular ejection fraction(LVEF) of cross-sectional echocardiography on the first day and the thirtieth days.In observation group,Panax Notoginsenoside Injection in dose of 400 mg was intravenous injected, and Panax Notoginsenoside Injection 400 mg was added saline250 ml was continued postoperatively injected intravenously once daily for 14 days of continuous use; All of patients from two groups with the guidelines routine were given oral aspirin and clopidogrel,and then given primary PCI in the cath lab underwent. The patients who didn’t need PCI directly were exclude from the group. All the patients was openedthe infarct-related artery within 90 minutes after signed an informed consent, intraoperative use of thrombus aspiration and tirofiban could be applied during the operation according to the situation PCI immediate postoperativeinfarct-related artery bloodflow after the opening under thecircumstances, the micro-circulation and myocardial perfusion were assessed bytwo experienced interventional physicianson the basis of TIMI flow grade and myocardial perfusion grade(TMPG), at the same time the incidence of no-reflow should be recorded; During the time in hospital after operation, all patients were givenoxygen inhalation,conditioning cholesterol, plaquestabilization, aspirin,clopidogrel and low molecular weight heparin, according to the patient’s condition to give Ⅱb/Ⅲ receptor antagonists, if there is no obvious contraindications will be given angiotensin converting enzyme inhibitors or angiotensin receptor antagonists and β-blockers as coronary heart disease medication basis. The primary endpoint of experients is that to observe cardiacmicrocirculatory perfusionduring operation,recent cardiac function and improvement of blood stasis signs. All the date was analysis by the SPSS19.0 software based on statistical theory.and compared the difference between the two groups andbetween before and after the treatment.Rresults: 1 Comparison of clinical data There were no statistically significant differences between the two groups in gender, age, weight, smoking history, history of myocardial infarction, history of hypertension, history of diabetes, history of hyperlipidemia, troponin, creatine kinase MB(P>0.05). 2 Comparison of intraoperative cardiac microcirculation conditions(1)No-reflow Compare:The present study about the overall incidence of no-reflow is 27.0%, in line with previous research statistics is from 10% to 30%; The no-reflow incidencetwo groupswas 19.4%, 34.4% respectively, in the observation group than the control group low incidence of no-reflow but the difference was not statistically significant(P>0.05).(2)Myocardial perfusion compare: In the observation group,there were 11 patientsabout Myocardial perfusion TMPG bloodstream <3, accounting for 35.5% of the observation group,and in the control group,there were 20 casesabout Myocardial perfusion TMPG bloodstream <3(62.5%), in the observation group the proportion of TMPG blood flow<3 was significantly lower than the control group(P<0.05), the difference was remarkable. 3TEG related indicators compare(1) Before treatment: The clotting reaction time(R), clot formation time(K), coagulation angle(Angle), maximum amplitude(MA) of both group showed no significant difference(P> 0.05).(2) After treatment: After treatment,the clotting reaction time(R)were increased in comparison with those before treatment in both groups,but there was no statistically significant(P>0.05);The clot formation time(K) were increased in comparison with those before treatment in both groups,the treatment group was increased more obviously than the control group and the difference was statistically significant(P<0. 05).The coagulation angle(Angle) were decreased in comparison with those before treatment in both groups,the treatment group was decreased more obviously than the control group and the difference was statistically significant(P<0.05).Themaximum amplitude(MA) were decreased in comparison with those before treatment in both groups,the treatment group was decreased more obviously than the control group and the difference was statistically significant(P<0.05). 4Thrombosis Hemostasis related indicators compare(1) Before treatment:The prothrombin time(PT), activated partial thromboplastin time(APTT), fibrinogen(FIB) value of two groups were no significant difference(P> 0.05).(2) After treatment between the two groups:The PT did not change significantly before and after treatment showed no significant difference of the both groups(P> 0.05); APTT was significantly longer than before, the change of the observation group is more obviousthan the control group,and showed significant difference(P<0.05); FIBwas lowerobvious than before,and the change of observation groupis more obviousthan the control group that has a significant difference(P<0.05) 5 Compare of stasis syndrome scores(1) Beforeand after treatment:Therehasno significant differences(P> 0.05)between two groups about stasis syndrome before treatment,and stasis syndrome of both groups decreased than before and the difference was statistically significant(P<0.05).(2) After treatment between the two groups:The BSS score of the observation group reduced more significantly than the control group, there was a remarkable difference.(P<0.05). 6 Recent evaluation of cardiac function(1) Before the treatment,the difference admission BNP level was not statistically significant between the observation group and the control groups(P>0.05);15 days after surgery, the difference of two groups has statistical significance(P<0.05); (2) Before the treatment,the difference admission LVEF level was not statistically significant between the observation group and the control group(P>0.05);1months after surgery, the difference of two groups has statistical significance(P<0.05); 7 Recent safety evaluation During the time in the hospitaland follow-up,the liver and kidney function, blood levels, of the two groups was monitored,and there is no case of severe liver and kidney dysfunction,platelet, hemoglobin serious decline, and both groups had no significant bleeding and other complications.In conclusion: 1In combination with Panax Notoginsenoside Injection therapycan effectively improve the microcirculation of the heart in STEMIpatients after PCIwithout increasing the risk of bleeding. 2 The Panax Notoginsenoside injection can improve blood clotting in patients with acute STEMI related indicators, and change hemodynamics, reduce myocardial ischemia,cell damage and improve recent heart functiontosome extent. 3 Using Panax notoginsenoside injectioncan significantly reduce the BSS score, effectively improve the situation of STEMI acute phase patients with blood stasis. |
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