| Objective:To investigate the effect of low-dose etibatide combined with coronary intervention(PCI)on blood perfusion,cardiac function and prognosis in patients with acute myocardial infarction(AMI).Method:1 Research objectFrom October 2018 to May 2019,98 patients with ST segment elevation myocardial infarction(STEMI)who were treated in the first Central Hospital of Baoding city for emergency PCI were randomly divided into two groups: experimental group and control group.Inclusion criteria:(1)age 18-75;(2)chest pain > 30 min,onset time < 12h;(3)indications of PCI in line with the latest STEMI treatment guidelines.Exclusion criteria: patients with severe(1)infection or high fever;patients with thrombolysis before PCI;pregnant(2)(3)or lactating women;(4)history of hemorrhagic cerebrovascular disease;(4)serious retinopathy(hemorrhage or exudation);serious hypertension(blood(6)pressure > 180 / 110mm)Hg);(7)aortic dissection;(8)patients with mental disorders or(and)unable to cooperate in diagnosis and treatment;patients(9)are allergic to etibatide,heparin and other drugs;patients with serious liver(10)and kidney dysfunction.2 Research methods2.1 The computer system of the patients who meet the admission criteria was randomly divided into the experimental group and the control group: the experimental group was given etibatide once(180ug/kg)intravenously during PCI,and was pumped 1 ug/(kg·min)intravenously after PCI,and maintained for 18 hours;the control group was not injected.2.2 Routine medicationAll patients took 300 mg aspirin enteric coated tablets and 180 mg tegrarol before PCI.After the operation,the patients were given aspirin enteric coated tablets(life-long)and tegrarol(at least 1 year);heparin was injected subcutaneously(5-7 days of application,and the international standardized ratio INR was rechecked regularly);the second-class preventive drugs for coronary heart disease were selected according to the actual situation of the patients.2.3 Coronary angiography processThe patient is in a supine position,the puncture site is routinely disinfected,the local infiltration is anesthetized,the puncture needle is used to puncture the right radial(femoral)artery,the guide wire is inserted after success,the sheath tube is inserted along the guide wire,the contrast guide wire and the contrast catheter are sent into the blood vessel through the outer sheath to the coronary artery for angiography,and the experienced physician(deputy chief physician and above)is used to interpret the results of angiography,and observe the stenosis of the culprit's blood vessel And blood supply.If the patients need further interventional treatment,they should be divided into three groups: the experimental group was given etibatide once(180ug / kg),followed by intravenous pump(1ug / kg / min)for 18h;the control group was directly selected balloon and stent.Finally,according to the degree and length of coronary stenosis,the appropriate balloon dilatation and stent placement were selected.2.4 Myocardial contrast echocardiography(MCE)The quantitative evaluation of myocardial perfusion was achieved by MCE 7 days after PCI.MCE was performed with EPIQ 7 ultrasound system.The patient rests in a supine position.Ultrasound contrast agent composed of sulfur hexafluoride filled microbubbles was initially injected intravenously at a rate of 0.9ml/min,and then the best image quality was obtained by reducing or increasing the rate.Use s5-1 scanners with a frequency of 1.0 to 5.0 MHz and a mechanical index as low as 0.10.After the stable infusion state,the microbubbles were destroyed from the myocardium to observe the supplement.To evaluate the microbubble supplement to myocardial microcirculation and obtain real-time images.3.Observation indicators(1)Clinical data: including age,gender,basic diseases,smoking history,Killip classification at admission,number of diseased vessels,number of implanted stents,time from onset to vascular opening,door to balloon(D2B),etc.(2)indexes of myocardial perfusion and cardiac function: ST segment(1)regression rate in 2 hours and TIMI blood flow classification after operation.(2)The peak value of myocardial enzyme and troponin(TNI).7 days after(3)operation,MCE: peak intensity(PI),time to peak(TP).(4)Left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(lved)and BNP were measured at 1 day,1 week and 1 month after treatment.(3)prognosis and complications: TIMI major bleeding,minor bleeding,slight bleeding and thrombocytopenia were recorded;all patients were followed up for 3 months by outpatient and telephone,and major adverse cardiac events(MACE)were recorded.4 Statistical methodsSpss22.0 software was used for analysis.The counting data is expressed in percentage(%),and chi square test is applied.T-test is applied to the measurement data conforming to normal distribution,and nonparametric rank sum test is applied to the measurement data not conforming to normal distribution or uneven variance,all of which are expressed as mean ± standard deviation.P < 0.05 was statistically significant.Result:1 Comparison of general data between the two groups: 98 cases were included in the study,50 cases in the experimental group and 48 cases in the control group.There were 37 males(74%)and 13 females(26%)in the experimental group,with an average age of 59.18±12.31 years;32 males(67%)and 16 females(33%)in the control group,with an average age of 61.27± 10.47 years.There was no significant difference between the two groups(P > 0.05).2 Comparison of myocardial zymogram,ECG and TIMI blood flow after operation: there was no significant difference in the peak value of CK,CK-MB,Tn I and the ratio of TIMI blood flow after operation between the experimental group and the control group(P>0.05).There was significant difference between the two groups(P<0.05).3 Comparison of myocardial contrast echocardiography results: the peak intensity(PI)of the experimental group was higher than that of the control group,and the peak time(TP)of the experimental group was lower than that of the control group,that is to say,the myocardial perfusion of the experimental group was better than that of the control group,the difference was statistically significant(P<0.05).4 Comparison of cardiac function indexes: there was no significant difference between the two groups(P>0.05).The left ventricular ejection fraction of the experimental group was higher than that of the control group,BNP level was significantly lower than that of the control group,that is,the heart function index of the experimental group was better than that of the control group,and the difference was statistically significant(P<0.05).5 Bleeding complications and follow-up results: there was no significant difference between the two groups(P>0.05).Conclusion:1 Low dose of etibatide can improve myocardial perfusion,cardiac function and prognosis in patients with acute stem.2 It is safe and reliable to use low dose etibatide without increasing the risk of bleeding and the incidence of mace. |
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