| Objective: To investigate the impact of application of recombinant human brain natriuretic peptide(rh BNP) on ST-segment elevationg myocardial infarction( STEMI) patients undertaking rescue percutaneous coronary intervention(PCI) of left ventricular function.Methods: Choosing patients with rescue PCI from September 2010 to November 2014 hospitalized in The Third Hospital of Hebei Medical University, a total of 41 cases, 23 cases were male and 18 were female. Inclusion criteria: 1.Patients aged 35 to 75 years old, killip class I ~ II. 2.According to the acute ST segment elevation extensive anterior wall myocardial infarction diagnostic criteria:Myocardial enzyme(c Tn I) level is more than 99% of the reference value, in the meantime with one of the following ischemia evidence:(1)new ischemic ECG changes, such as new ST-T or T wave changes, new left bundle branch block(LBBB)or the formation of pathological Q wave, radiographic indicate new segmaental wall motion abnormalities,(2)new evidence of thrombosis confirmed by coronary angiography with symptoms of myocardial ischemia and(or) cardiogenic sudden death(including heart arrest), 3.All patients are accorded with the indications of thrombolytic therapy and take thrombolytic therapy. 4.Patients suffered from STEMI in 12 hours, and accept rescue PCI in 24 hours. 5.All patients volunteered for the research, signed the informed consent and follow-up on time. Exclusion criteria:(1)The age of patients is above 75-year-old,(2) Existence of sustained tachycardia, atrial fibrillation, ventricular fibrillation,(3) Systolic pressure is below 90 mm Hg,(4)Patients have acute pump failure condition, congenital heart disease, primary pulmonary hypertension, erious myocardial diseases,(5)Be with insufficiency of liver or renal, cardiac insufficiency, tumor, hemagglutination insufficiency, serious infection, anemia,aortic dissection, pulmonary embolism,(6)Have history of heart failure or myocardial infarction,(7)Vasodialator medication is not allow to use,(8)Taking experimental medicine or other non-cardiovascular drug,(9)Allergic to aspirin, clopidogrel, vasodialator medication, low molecular weight heparin, metal or contrast media,(10) Patients themselves or other family members refused to join in the research. Using the random digital table, randomly divided the 41 patients into two groups, the rh BNP group and the control group. There are 22 cases in the rh BNP group and other 19 cases in the control group. After preoperative preparation for all patients, perform coronary angiographemergency by using radial artery, ulnar artery or femoral artery. Non-ionic low permeability contrast media is used in coronary angiographemergenc. After coronary angiographemergenc was performed, all patients accepted rescue PCI based on the characteristics of infarction related artery and were implanted drug-eluting stents in infarction position and was gived conventional worship of aspirin and clopidogrel dual antiplatelet, low molecular heparin anticoagulation, treatment ester and anti-atherosclerotic effect of atorvastatin by doctors. After the successful rescue PCI, rh BNP group was immediately gived intravenous recombinant human brain natriuretic peptide( rh BNP), under experienced above 10 years physician premise closely detectiong, dosages should be decided according to weight(the loading dose of 1.5μg/kg), intravenous injection was completed in 3-5min, and make sure that systolic blood pressure is above 90 mm Hg, in 0.0075μg.kg-1.min-1continuous intravenous trace pumping in 72 hours. Meanwhile, the dose of rh BNP can be adjusted according to condition of patients or actual situation. Rh BNP is not gived to the control group after the successful rescue PCI. After rescue PCI, using killip classification method to evaluate the cardiac function after performing rescue PCI 24 h, 48 h and 72 h in both groups. Two groups are returned 2m1 venous blood for detection of the NT- pro BNP level at the time of admission, rescue PCI postoperative 24 h, 48 h and 72 h. Both group were received two-dimensiona echocardiography examination at same hospital in one week after rescue PCI to assess the left ventricular end-diastolic diameter and ejection fraction. The major adverse cardiacevents of both groups was observed and recorded within 3mouths from hospitalization, including heart failure deterioration(killip classification increases greater than or equal to one level), malignant arrhythmia(continuous ventricular tachycardia, ventricular fibrillation and atrial fibrillation), recurrent myocardial infarction, admission because of serious coronary heart disease, target vessel revascularization and cardiac death. Using the SPSS20.0 statistical software to analyse the monitoring data. Taking P < 0.05 as significant statistically difference, have statistical significance.Results:1 Comparing the rh BNP group with the control group in baseline data: There are no significant difference in general conditionage(age and gender), complications(hypertension, diabetes and hyperlipidemia), smoking status. There are no significant difference in levels of NT-pro BNP, killip classification on admission, IRA and TIMI Flow, all P > 0.05.2 Changes of NT-pro BNP level in the two groups: Rh BNP group of NT-pro BNP level(ng/L) in postoperative 24 hours, 48 hours, 72 hours were 740.73±167.96、591.45±111.06、442.41±120.88,The control group patients postoperative 24 hours, 48 hours, 72 hours of NT-pro BNP level(ng/L) are 856.63±149.20、705.79±125.83、662.68±133.43.The NT-pro BNP level Copared between the two groups of postoperative 24 hours, 48 hours, 72 hours was statistically significant(P<0.05). Rh BNP group is lower than the control group.3 Comparison between rh BNP patients and the control group group in Killip classification: Killip classification of rh BNP grouping postoperative 48 hours, 72 hours is lower than the control group.(P<0.05)4 Comparison of echocardiography results between rh BNP group and the control group in one week after rescue PCI: Ejection fraction of rh BNP group is higher than the control group and left ventricular diastolic diameter of rh BNP group is is lower than the control group(P<0.05).5 Comparison of MACE rh BNP group and the control group in three mouths : MACE rate of rh BNP group is lower than the control group(P<0.05).Conclusion:For patients who suffer from nonreperfusion and accept rescue PCI, early application of rh BNP can play a role in protecting damaged heart muscle cells after acute myocardial infarction, improving myocardial perfusion, reducing the effects of rescue PCI, improving left ventricular function, and prognosis. |
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