经皮冠状动脉介入术中静脉应用盐酸艾司洛尔对急性ST段抬高型心肌梗死患者临床疗效及安全性

孙冰; 王海昌; 王海燕

doi:10.12125/j.chj.201909015

经皮冠状动脉介入术中静脉应用盐酸艾司洛尔对急性ST段抬高型心肌梗死患者临床疗效及安全性

To investigate the efficacy and safety of intravenous Esmolol in patients with acute st-elevation myocardial infarction (STEMI) during PCI.

摘要

摘要:
目的观察急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入（PCI）术中静脉应用盐酸艾司洛尔（Esmolol）的临床疗效及安全性。
方法收集唐都医院心内科收治的STEMI患者117例并将其分为盐酸艾司洛尔（Esmolol）组（试药组，n = 59）和安慰剂对照组（对照组，n = 58）。主要观察终点为PCI术后24 h肌钙蛋白的实验室结果。次要观察终点为术后90 min心电图ST改变，术后3 d、6周、12周和24周复查心脏彩超，24周随访时填写西雅图SAQ量表，统计出院24周期间的主要不良心血管事件（MACE）。
结果两组患者一般情况、危险因素、临床用药及其他治疗情况比较均无统计学意义。两组主要终点事件比较，心肌肌钙蛋白（cTn）I（ng/ml）13.70（7.74,33.80） vs. 26.05 （10.70,57.90）, P < 0.05,差异有统计学意义，肌酸激酶同工酶（CK-MB）（ng/ml）8.22(4.07,23.50) vs. 22.95(4.00,57.63)，P < 0.05，差异有统计学意义，两组次要终点事件比较术后24周左室射血分数（LVEF）57(52,65) vs. 53 (48,57), P < 0.01，差异有统计学意义，术后90 min心电图ST段回落比例 > 50%（P < 0.01），差异有统计学意义。
结论 PCI术中静脉应用中、低剂量盐酸艾司洛尔可降低STEMI患者的心肌损伤，改善心肌缺血，提高术后24周LVEF，且具有安全性。

Abstract:
AIM To investigate the efficacy and safety of intravenous Esmolol in patients with acute st-elevation myocardial infarction (STEMI) during PCI.
METHODS A total of 117 STEMI patients were enrolled and divided into Esmolol group (n = 59) and placebo group (n = 58). The primary outcome was the laboratory results of troponin T 24 hours after PCI. The secondary observation end point was the change of ST on ECG at 90 min after PCI, and the echocardiography was reexamined at 3 days, 6 weeks, 12 weeks and 24 weeks after the operation. The Seattle SAQ scale and the major adverse cardiovascular events (MACE) was collected at 24 weeks out of hospital.
RESULTS There were no significant differences in general situation, risk factors, clinical medication and other treatment conditions between the two groups (P > 0.05). cTnI (ng/ml) (13.707.74-33.80 vs. 26.05 10.70-57.90, P = 0.028) and CK-MB (ng/ml) 8.22 (4.07,23.50) vs. 22.95 (4.00,57.63), P < 0.05) showed significant differences. Additionally, we observed that intravenous Esmolol significantly improved the ejection fraction of left ventricle of Esmolol group (LVEF) 57 (52, 65) vs. 53(48,57), P < 0.01) at 24 weeks after the operation. There was also significant difference about the ST segment decrease of 50% (P < 0.01) at 90 min after the operation.
CONCLUSION intravenous Esmolol during PCI can reduce myocardial injury, improve myocardial ischemia and left ventricular ejection fraction in patients with acute st-elevation myocardial infarction (STEMI).

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