| ObjectiveAcute Myocardial Infarction?AMI?is ischemic necrosis of the myocardium.On the basis of coronary artery disease,a sharp reduction or interruption of coronary blood supply occurs,resulting in severe and prolonged Acute ischemia of the corresponding myocardium leading to Myocardial necrosis.For patients with acute myocardial infarction,after effective revascularization,the majority of patients achieved vascular recanalization,and the clinical symptoms such as chest tightness and chest pain were improved.A small number of patients still had symptoms of angina pectoris,indicating that there may be microcirculation disorder and perfusion at the level of myocardial tissue was not achieved.The presence of microcirculation disorder is an important factor in myocardial ischemia and myocardial remodeling,and is also an important indicator to evaluate the success of reperfusion.Currently,there is no definite therapeutic drug to improve myocardial microcirculation disorder,but it has been found in clinical practice that nicotil can improve myocardial microcirculation to a certain extent and has a rapid effect.The dilatation of coronary arteries of nicotil is related to the atp-sensitive K ion channel opening and the guanosine cyclase.Pharmacological action mechanisms include preventing intracellular calcium ion dissociation,increasing the permeability of cell membrane to potassium ions,dilating coronary vessels,continuously increasing coronary artery blood flow,and inhibiting coronary artery spasm.When dilating coronary vessels,blood pressure,heart rate,myocardial contractility and myocardial oxygen consumption are not affected[1].Nicotil belongs to western medicine preparation,because coronary heart disease is a chronic disease,the need for oral medicine to maintain,long-term treatment.In recent years,in the national Ministry of Science and Technology take the lead in qi and invigorate the circulation of Chinese traditional medicine in acute myocardial infarction,improve improve myocardial perfusion has played a unique role,PQS as oral drugs,the animal experiments and clinical applications,have been suggested to improve myocardial energy metabolism,resisting myocardial remodeling,etc,and side effect to human body small,can be long-term use of[2].In this study,the total saponins from the stems and leaves of panax quinquefolium were added on the basis of nicotil to observe whether it could further improve the microcirculation disorder after acute myocardial infarction,so as to find a more effective treatment.At present,there is no relevant research report.Therefore,this study aims to investigate the improvement effect of nicotil combined with PQS on the microcirculation disorder after acute myocardial infarction.Research purposeObjective:to investigate the effect of nicotil combined with PQS on the improvement of microcirculation disorder after acute myocardial infarction,and to increase the clinical benefit of patients after acute myocardial infarction.Method56 patients admitted to China-Japan Union Hospital of Jilin University from January 2019 to January 2020 for a definite diagnosis of acute st-segment elevation myocardial infarction were selected as research objects,and randomly divided into the total saponin group+nicodil group?test group 1?,nicodil group?test group 2?and control group.Preoperative loading doses of aspirin?300mg?and clopidogrel?300mg?or tigrillo?180mg?were administered orally.All the patients in the 3 groups were treated with routine therapy such as double antibody.PQS?xinyue capsule??specification:0.3g/capsule,24capsules/box,approval no.:Z20030073?,0.6g/time,oral administration,3 times/day.Nicodil?Beijing sihuan kebao pharmaceutical co.,LTD.Specification:12mg/stick,4 sticks/box,the national drug approval word H20120069?,12mg/day,the test group 1 and the test group 2 all after the static point for 7 days.In the test group 1,the total saponins from the stems and leaves of panax quinquefolium were taken immediately after the operation.Age,previous history?hypertension,diabetes?,smoking,st-segment depression,Killip grading,cardiac troponin,and portal-ball time were recorded.The left ventricular end-diastolic diameter?LVEDD?and left ventricular ejection fraction?LVEF?were evaluated by myocardial nuclide score and color doppler ultrasound on the 7th and30th day after surgery.Abdominal venous blood was evacuated 3 and 30days after PCI,and the values of neutrophils and lymphocytes in blood routine were determined.Values of fibrinogen and albumin in biochemistry.Results1.Statistical analysis of the basic data of the three groups of subjects showed that there were no significant differences in age,hypertension,diabetes,smoking,st-segment depression,Killip grading,cardiac troponin,and portal ball time among the three groups.2.Patients in the three groups underwent single electron emission computed tomography?SPECT?score at 7 and 30 days after surgery:comparison of test group 1 and test group 2 and control group 7 days after surgery was statistically significant?31.20±1.08 vs 31.86±0.99 vs32.47±0.61 p<0.05?;comparison of test group 1 and test group 2?31.20±1.08 vs 31.86±0.99 p>0.05?was not statistically significant.The difference between the experimental group 1 and the experimental group2 was statistically significant?30.27±1.03 vs 31.18±1.37 vs 31.79±1.32 p<0.05?,and the difference between the experimental group 1 and the experimental group 2 was statistically significant?30.27±1.03 vs31.18±1.37 p<0.05?.Nicotil can improve myocardial blood flow by dilating coronary artery microvessels,and the improvement effect can be improved by combining the total saponins from the stems and leaves of panax quatica.And with the increase of time,the improvement effect is more obvious;3.The NLR results of the three groups 3 days after the operation showed:the experimental group 1,the experimental group 2 and the control group(4.59±0.70 vs 5.01±0.59 vs 5.10±0.43 p<0.05,the difference was statistically significant.30 days after surgery,there was no statistically significant difference between the experimental group 1,experimental group 2 and control group?2.81±0.53 vs 2.76±0.39 vs 2.87±0.36P>?.The fibrinogen/albumin?FAR?value was 0.15±0.04 vs 0.17±0.04 vs0.18±0.03 p<0.05 3 days after surgery and 0.14±0.04 vs 0.15±0.03 vs0.15±0.04 p>0.05 30 days after surgery.It is suggested that the early application of nicotil and total saponins in the stems and leaves of panax quemoginseng can reduce the inflammatory response caused by acute myocardial infarction,reduce the activation of neutrophils,and inhibit the release of inflammatory factors.Reduce microthrombus formation,and protect cardiac muscle cells?4.Results of left ventricular end-diastolic diameter?LVEDD?and left ventricular ejection fraction?LVEF?in the three groups were as follows:LVEDD?59.53±1.76 vs 59.14±1.67 vs 58.79±2.09 p>0.05?and?59.07±1.83 vs 58.14±1.58 vs 57.74±2.05 p>0.05?at 7 and 30 days after surgery.Left ventricular ejection fraction?47.33±2.29 vs 47.27±2.49 vs46.37±1.98 p>0.05?,?50.27±2.63 vs 50.00±2.45 vs 48.05±2.55 p<0.05?,suggesting that the use of total saponins from the stems and leaves of panax panax could improve the utilization of energy and increase myocardial ejection by using nicotil.Conclusion1.Nicotil combined with total saponins from the stem and leaves of panax panax can reduce the early inflammatory response of myocardial infarction,reduce the activation of neutrophils,inhibit the release of inflammatory factors,and protect myocardial cells.2.The combination of total saponins from stem and leaf of panax quatica and nicotil can improve the energy metabolism of cardiomyocytes,improve the efficiency of cardiac work and increase the left ventricular ejection fraction;3.Nicotil combined with PQS improved blood perfusion,and SPECT could reflect the improvement of prognosis by perfusion imaging score. |
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