| Objective: Acute myocardial infarction is a sudden rupture of unstable plaque existing coronary acute coronary thrombosis or stenosis in the originalfixed on the basis of a result of occlusion, resulting in myocardial sudden interruption of blood supply, causing a large area of myocardial necrosis. The disease is most common in Europe, with the improvement of living standards, China in recent years, the prevalence of acute myocardial infarction presents an upward trend. The acute phase of acute myocardial infarction mortality With advances in medical technology continues to decrease in recent years, application of percutaneous coronary intervention after treatment decreased to 4% to 6%. However, reducing the mortality of acute myocardial infarction is by no means the end of our treatment, and how to prevent reinfarction, how to maximize the inhibition of myocardial remodeling and improving cardiac function and prognosis after surgery has become placed in front of the medical workers in the new issues. At present, a large number of studies have confirmed the correlation between high homocysteine and cardiovascular disease Hyperhomocysteinemia either P53 or by influencing or affecting mitochondrial DNA, from the aggravation of left ventricular remodeling In theory expounded was established, well-known, folic acid in patients with lower homocysteine levels in effect, while folic acid itself can also improve cardiovascular endothelial function, arterial delay the progression of atherosclerosis. Enalapril belongs to angiotensin-converting enzyme inhibitor class of drugs, myocardial cells have multiple protection, such as scavenging oxygen free radicals, reduce the production of angiotensin II in the heart, dilation of blood vessels, etc., can inhibit myocardial remodeling related action, enalapril folic acid tablets are synthetic preparation of new listings in recent years, this study mainly affect enalapril folic acid tablets after acutemyocardial infarction in patients undergoing emergency PCI homocysteine levels and prognosis.Methods: We totally enrolled 30 cases of acute myocardial infarctionand in patients undergoing emergency PCI. Inclusion criteria: age 50 years to 75 years, weighing 45Kg-80 Kg, due to acute myocardial infarction admitted to hospital after admission to the emergency PCI treatment for LAD culprit artery and LAD occlusion of the middle part, since the onset of patency time to 2-6 hours between 2 weeks before the disease did not take folic acid, ACEI or ARB drugs; patients were randomly divided into experimental group and control group, the experimental group took enalapril folic acid tablets, consistent with the rest of the treatment.Experimental group: Take enalaprilat folic acid tablets group(group A) and take enalaprilat tablet group, two groups of patients with similar to the rest, strictly low salt, low fat diet, strict control of blood pressure, blood sugar, regular use 0.1 o worship department horse spirit GQD, 75 MGQD clopidogrel, rosuvastatin 10 MGQN take beta-blockers, according to the blood pressure, heart rate situation.Experiment process:(1) The patients of acute chest pain immediately after admission to perfect the electrocardiogram inspection, if lead electrocardiogram(ecg) revealed breast ST segment elevation, an immediate thanks to 300 mg of aspirin chewing, clopidogrel 600 mg orally, giving blood during urgent check folic acid, homocysteine and other indicators related to myocardial infarction, and emergency heart colour to exceed examination, at the same time actively preparing for preoperative preparation. With the approval of the patient’s family emergency PCI after surgery, emergency the CAG prompt LAD middle 100% occlusion, incorporated in the experimental standard.(2) In strict accordance with the emergency PCI in patients with postoperative nursing standards, strict bed rest, reduce the visitation, low salt, low fat diet, smoking, drinking, according to patients recovery 10-14 days after discharge.(3) After surgery and after discharge law taking 0.1 o worship department horse spirit GQD, 75 MGQD clopidogrel, rui shu laval statin 10 MGQN, isosorbide nitrate ester mgtid take beta-blockers, according to the blood pressure, heart rate, in which the experimental group and 10.8 MGQD enalaprilat folic acid tablet, the control group taking enalaprilat MGQD 10, two groups of patients are outpatient follow-up on a regular basis.(4) Four months after PCI, the patients were followed including echocardiographic examination, homocysteine level, cases of patients after discharge presence of angina pectoris attack, NYHA classification. When necessary, with the approval of the patients coronary angiography was prefered in order to make clear whether there is complicated stent restenosis.Results:1 There is no significant statistical differences in age, weight and height, preoperative heart function classification in New York in two groups.2 Four months after the PCI, in experimental group homocysteine is significantly reduced, much lower than that in the control group, with statistical significance(P<0.05).3 Four months after the PCI, follow-up review increasing rate of echocardiographic LVEDD, EF value to reduce the rate of experimental group was significantly reduced, there is statistical significance by statistical analysis.4 The experimental group postoperatively in patients with angina pectoris, the control group with 4 patients with angina, comparing the two groups(P<0.05), there is statistical significance.5 According to the New York heart function classification standard, we evaluated the cardiac function in the two groups, experimental group heart function in patients with grade I seven, seven patients with cardiac function grade II, 1, not intentional function in patients with cardiac function grade III level IV patients;Control group patients with cardiac function grade I eight, six patients with cardiac function grade II, 1, not intentional function in patients with cardiac function grade III level IV patients. Comparison between the two groups revealed no statistical significance.(P>0.05)6 In the experimental group there is no postoperative recurrence of myocardial infarction, while in the control group there is 1 case of recurrence of myocardial infarction, there is no statistical significance(P>0.05).Conclusion: Compared with enalaprilat, enalaprilat folic acid tablets patients can more effectively reduce homocysteine levels in patients with acute myocardial infarction and underwent emergency PCI postoperative reduce the increasing rate of left ventricular end-diastolic diameter, EF value lower rate, with some success, can effectively reduce after myocardial infarction in patients with angina pectoris attack, but to avoid postoperative recurrence patients with myocardial infarction and the effect of postoperative cardiac function(NYHA classification method) is unclear. |
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