| Objective:To investigate the influence of intracoronary recombinanthuman brain natriuretic peptide(rhBNP) on the acute myocardial infarction(AMI) patients with percutaneous coronary intervention (PCI) ofpostoperative myocardial cell protection.Methods:Selected patients from March2012to November2013hospitalized in The Third Hospital of Hebei Medical University, sufferedfrom acute myocardial infarction in12hours, a total of50cases,30caseswere male and20were famales, age from35-75, mean age was59.1±10.94years.Inclusion criteria:1,Patients aged35to75years old, killip class I~II;Persistent chest pain to selected time <12h;2， in line with the2007ACC/AHA/ESC/WHF acute ST segment elevation extensive anterior wallmyocardial infarction diagnostic criteria：Cardiac biochemical markers (cTnI)levels is more than99%of the reference value, at the same time with one ofthe following ischemia evidence：(1)new ischemic ECG changes, new ST-Tchanges or new left bundle branch block(LBBB), electrocardiogram promptedthe formation of pathological Q wave or radiographic evidence suggest newsegmaental wall motion abnormalities of myocardial viability loss;(2) suddencardiac death(cadiac arrest),with symptoms of myocardial ischemia,and(or)new thrombosis evidence confirmed by coronary angiography;(3)acute myocardial infarction finding by pathologic evidence.3.Confirmed byemergency coronary angiography infarction related to vascular disease to leftanterior descending coronary artery lesions in the anterior descending branchin or near the middle and the vascular diameter3mm or more.All patientsvolunteered for and follow-up on time, signed informed consent.Exclusioncriteria:(1) Non st-elevation extensive anterior wall myocardial infarction,or the infarction related artery is not anterior descending；(2) Cardiac shock,insufficient blood volume not suitable for vessels dilation drugs；(3) patientswith Severe hepatic insufficiency, orrenal insufficiency；(4) existence ofinfectious diseases, autoimmune diseases, severe trauma, homorrhagicdisease,or with tumor;(5) Allergic to contrast agents or recombinant humanbrain natriuretic peptide；(6) age≥75years;(7) patients with PCIcontraindication;(8) patients after thrombolytic therapy;(9) patientsthemselves or other family members refused to participate in this study.Afterselected the patients, using the random digital table, randomly divided theminto two groups, the rhBNP(recombinant human brain natriuretic peptide)group and the routine treatment group.There are25cases in the rhBNP groupand other25cases in the routine treatment group. All patients improvedpreoperative preparation, emergency right radial artery or the right femoralartery coronary angiography. Contrast agents using ionic low permeabilitycontrast agents used in surgery.All selected based on the characteristics ofcoronary artery lesions line of PCI in patients with anterior descendingopening, both the anterior descending in infarction position implanteddrug-eluting stents and conventional worship of aspirin and clopidogrel dualantiplatelet, low molecular heparin anticoagulation, atorvastatin treatmentsuch as ester, stable plaques.After descending branch of the successful rhBNPgroup treated with PCI, instantly giving intravenous recombinant human brainnatriuretic peptide(rhBNP),intravenous the loading dose of1.5μg/kg,5minintravenous injection was completed,and to ensure that systolic blood pressure≥90mmHg, had experienced physician premise closely detection,in0.0075μg.kg-1.min-1continuous intravenous trace pumping72hours,can be adjustedaccording to the actual circumstance of the patient carefully during thedose.The control group did not give rhBNP treatment. All of the patients inhospital instantly,24hours,48hours and72hours respectively to return2m1venous blood, detection of serum CK-MB and the NT-proBNP level.Emergency PCI postoperative24h,48h and72h according to the evaluationof cardiac function in patients with killip classification method. All the patients received two-dimensiona echocardiography examination at hospitaldischarge.The major adverse cardiacevents of patients was Observed andrecorded during hospitalization and after discharge1months, includingmalignant arrhythmia, myocardial infarction and death happened.Applicationthe SPSS19.0statistical software to analyse the monitoring data. Using P＜0.05as significant statistically difference, have statistical significance.Results:1The rhBNP group compared with the control group,there were no significantdifference in age, gender, complications, and time, etc.There were nosignificant difference in levels of NT-proBNP and CK-MB, all P>0.05.2Changes of CK-MB level in the two groups:RhBNP group of patientspostoperative24hours,48hours,72hours of CK-MB level (μg/L) were84.12±11.38、16.96±8.43、5.12±2.11;The control group patients postoperative24hours,48hours,72hours of CK-MB level (μg/L) were91.16±12.99、24.68±11.27、8.44±3.81.The level of two groups of CK-MB peaked in24hours, and then began to fall.Comparison between the two groups ofpostoperative24hours,48hours,72hours of CK-MB level was statisticallysignificant (P <0.05).RhBNP group CK-MB level is lower than the controlgroup.3Changes of NT-proBNP level in the two groups:RhBNP group of patientspostoperative24hours,48hours,72hours of NT-proBNP level(ng/L) were780.76±134.81、570.32±112.45、439.36±102.71;The control group patientspostoperative24hours,48hours,72hours of CK-MB level ng/L were876.44±124.83、750.40±101.24、628.16±118.73.The level of two groups ofNT-proBNP peaked in24hours, and then began to fall.Comparison betweenthe two groups of postoperative24hours,48hours,72hours of the NT-proBNP level was statistically significant（P＜0.05）.RhBNP group NT-proBNP level is lower than the control group.4RhBNP patients postoperative cardiac function and the control grouppatients were poor in preoperative, rhBNP patients postoperative24hours,48 hours,72hours of heart function classification were better than the controlgroup5Comparing the two groups of patients discharged from hospitalechocardiography results:two groups of patients with ventricular septalthickness and left atrial diameter was no statistical difference（P＞0.05）; leftventricular diastolic diameter and ejection fraction of RhBNP group is betterthan the control group（P＜0.05).6RhBNP patients compared with control group: rhBNP group of patientswithin1month MACE rate is lower than the control group（P＜0.05）.Conclusion:For st-elevation acute extensive anterior wall myocardial infarctionpatients after the emergency PCI, early application of rhBNP can not onlyimprove the prognosis of patients with long-term use can also be in the shortterm to protect damaged heart muscle cells after acute myocardial infarction,reduce the adverse effects of PCI surgery of, reduce the incidence of acuteheart failure, and maximize the benefit from the emergency PCI patients. |
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