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目的探讨急性心肌梗死患者接受早期再灌注治疗后血浆脑钠素水平和左心室重塑的变化。方法急性心肌梗死患者56例,胸痛发作12h内接受并成功再灌注治疗者(38例)为试验组,未接受再灌注或再灌注治疗失败者(18例)为对照组。ELISA法测定入院即刻、24h、48h、7d、14d、28d时血浆脑钠素水平;入院后3~5d、28d超声心动图测量左心室舒张末期容积指数、左心室收缩末期容积指数、左心室射血分数,并计算他们的变化量。结果①急性心肌梗死患者血浆脑钠素水平较正常人明显升高;试验组血浆脑钠素水平呈单峰曲线,对照组呈双峰曲线;再灌注可明显降低急性心肌梗死患者脑钠素水平,其第7天时浓度升高不明显,未形成第2个高峰。②再灌注治疗能减少左心室容积增加并提高左心室射血分数。③血浆脑钠素水平与急性心肌梗死后左心室重塑的程度相关,尤其以急性心肌梗死后第7天时脑钠素浓度最有意义。结论早期再灌注治疗可明显降低急性心肌梗死患者血浆脑钠素水平并减轻左心室重塑,血浆脑钠素水平与急性心肌梗死后左心室重塑的程度相关。
Objective To investigate the changes of plasma brain natriuretic peptide and left ventricular remodeling after acute reperfusion in patients with acute myocardial infarction. Methods Fifty-six patients with acute myocardial infarction (AMI) and 38 patients with successful reperfusion within 12 hours after onset of chest pain were selected as the experimental group and those who failed to receive reperfusion or reperfusion therapy as control group. The levels of plasma brain natriuretic peptide were measured by ELISA at 24h, 48h, 7d, 14d, 28d after admission. The left ventricular end diastolic volume index, left ventricular end-systolic volume index, left ventricular ejection fraction Blood scores, and calculate their changes. Results ① The levels of plasma brain natriuretic peptide in patients with acute myocardial infarction were significantly higher than those in normal controls. The levels of plasma brain natriuretic peptide in experimental group showed a single peak curve and the control group showed a bimodal curve. Reperfusion could significantly decrease the level of brain natriuretic peptide in patients with acute myocardial infarction , The seventh day when the concentration was not significantly increased, did not form the second peak. Reperfusion therapy can reduce left ventricular volume and increase left ventricular ejection fraction. Plasma BNP levels correlate with left ventricular remodeling after acute myocardial infarction, especially when brain natriuretic peptide concentration is the most significant at day 7 after acute myocardial infarction. Conclusion Early reperfusion therapy can significantly reduce the levels of plasma brain natriuretic peptide and relieve left ventricular remodeling in patients with acute myocardial infarction. The level of plasma brain natriuretic peptide is correlated with the degree of left ventricular remodeling after acute myocardial infarction.