Efficacy Of Nippv In Treating AMI With Acute Left Cardiac Functional Insufficiency After PCI

ObjectiveThis study aims to assess the efficacy of non-invasive positive pressure ventilation(NIPPV) in treating AMI with acute left cardiac insufficiency after PCI and to observe the changes of neuroendocrine system due to NIPPV .MethodsForty patients with acute left cardiac insufficiency consequent on AMI verified by CAG and treated with PCI during the period from Jan.2007 to Jul. 2008 were randomized divided into experimental group(EG=20) and control group (CG=20)while being interfered with standard oxygen therapy and NIPPV respectively. The plasma levels of several neuroendocrine factors including plasma renin activity ( PRA) , aldosterone (ALD) ,angiotensinⅡ(AngⅡ), norepinephrine (NE) and epinephrine (E) as well as cardiac injury markers(MYO,CK-MB,cTnI) in both groups were measured on the days of 1, 2, 3 ,5 ,7,10 after the different interventions.In addition, SpO2 was measured at the same time and Left ventricular ejection fraction (LVEF) was evaluated after treantments.Finally, statistics was token to analysis the data.ResultsSignificant difference in SpO2 was found on the first day(p<0.0001)and in LVEF on the tenth day( p<0.0001) . There were distinctly differences in neuroendocrine factors and cardiac injury markers between EG and CG. The concentration-time curves of PRA,AngⅡ,ALD,NE and E showed that no differences were observed on the first day, but differences began to occur on the second or third day between the two groups. [PRA:on the first day 3.09±0.32 vs 2.96±0.37 ug.L-1/h (p = 0.2590) ,on the second day 2.65±0.38vs3.05±0.43 ug.L-1/h (p = 0.0038) ; AngⅡ:on the first day 187.72±26.12vs173.16±41.66 ng/L ( p = 0.1934) ,on the third day 148.52±25.15vs176.51±21.89 ng/L ( p = 0.0006) ; ALD:on the first day 185.09±16.86vs182.44±15.52 pmol/L(p = 0.6083),on the third day 151.24±16.66 vs 179.21±18.79pmol/L(p<0.0001); NE: on the first day 3070.20±228.74 vs 3031.20±202.37pmol/L(p=0.5713);on the second day 2842.08±318.63vs3149.82±299.16 pmol/L (p=0.0032);E:on the first day 600.34±60.16vs602.78±25.93pmol /L (p= 0.8689 ) ;MYO:on the first day 293.82±183.72vs217.78±105.33ng/mL(p=0.1166),on the third day 307.34±91.29vs386.28±48.43 ng/mL(p=0.0015);CK-MB:on the first day 8.84±3.96vs7.94±3.14 ng/mL(p=0.4322),on the third day 13.24±4.54vs 16.03±4.03 ng/mL(p=0.0471);cTnI on the first day 3.74±3.13vs3.68±4.02 ng/mL(p=0.9603),on the third day 11.44±4.25vs 14.88±4.83 ng/mL (p=0.0217)]。Though the factors and markers in both groups declined to normal on the tenth day, differences was existing. Linear correlation and canonical correlation analysis indicate that there's correlations between sympathetic nervous system and RAAS (p<0.0001)and both related to cardiac injury markers.ConclusionNIPPV which can inhibit neuroendocrine activation and minimize myocardial damage is a effective therapy for the pationts with acute left cardiac insufficiency duo to AMI after PCI.