2018 年第 4 期 第 13 卷

还原型谷胱甘肽联合阿替普酶对老年急性心肌梗死患者再灌注的影响

Effect of reduced glutathione combined with alteplase on reperfusion in elderly patients with acute myocardial infarction

作者：王一涵姚雨蒙范莉萍韩颖

英文作者：

单位：150001哈尔滨医科大学附属第一医院干部四病房（王一涵、范莉萍、韩颖），呼吸内科重症监护病房（姚雨蒙）

英文单位：

关键词：急性心肌梗死；再灌注；还原型谷胱甘肽；阿替普酶

英文关键词：

• 摘要：

• 目的    探讨还原型谷胱甘肽联合阿替普酶对老年急性心肌梗死患者再灌注的影响。方法    选取2015年1月至2017年1月哈尔滨医科大学附属第一医院收治的老年急性心肌梗死患者116例，采用随机数字表法将患者分为观察组与对照组，各58例。对照组采用阿替普酶进行再灌注治疗；观察组在对照组基础上联合还原型谷胱甘肽治疗。比较2组再灌注疗效和治疗前后实验室指标、心功能指标及不良反应发生情况。结果    观察组患者治疗总有效率明显高于对照组［96.6%（56/58）比81.0%（47/58）］，差异有统计学意义（P=0.006）。治疗前，2组心肌肌钙蛋白T、肌酸激酶同工酶、心肌肌钙蛋白I、超氧化物歧化酶与还原型谷胱甘肽水平比较差异无统计学意义（P＞0.05）。治疗后，观察组心肌肌钙蛋白T、心肌肌钙蛋白I水平明显低于对照组［（0.764±0.283）U/L比（1.242±0.442）U/L、（0.752±0.343）μg/L比（1.521±0.572）μg/L］，肌酸激酶同工酶、超氧化物歧化酶与还原型谷胱甘肽水平明显高于对照组［（30±4）U/L比（23±3）U/L、（77±8）U/L比（65±6）U/L、（856±68）U/L比（659±57）U/L］（均P＜0.05）。治疗前，2组左心室收缩末期内径、左心室舒张末期内径与左心室射血分数比较差异无统计学意义（P＞0.05）,治疗后，2组左心室收缩末期内径、左心室舒张末期内径明显低于治疗前，左心室射血分数明显高于治疗前，且观察组左心室收缩末期内径、左心室舒张末期内径明显低于对照组［（40±7）mm比（50±8）mm、（51±5）mm比（60±8）mm］，左心室射血分数明显高于对照组［（74±10）%比（59±9）%］，差异均有统计学意义（均P＜0.05）。观察组患者不良反应发生率明显低于对照组［5.2%（3/58）比24.1%（14/58）］，差异有统计学意义（P=0.003）。结论    还原型谷胱甘肽联合阿替普酶有助于改善老年急性心肌梗死患者再灌注疗效，降低心肌再灌注损伤程度，改善心功能，降低不良反应发生风险。

• Objective    To explore the effect of reduced glutathione（GSH） combined with alteplase on reperfusion in elderly patients with acute myocardial infarction. Methods    Totally 116 elderly patients with acute myocardial infarction admitted from January 2015 to January 2017 in the First Affiliated Hospital of Harbin Medical University were randomly divided into observation group and control group, with 58 cases in each group. The control group had alteplase reperfusion therapy; the observation group had GSH combined with alteplase reperfusion therapy. Laboratory indicators, cardiac function indexes and adverse reactions were analyzed. Results   Total effective rate in observation group was significantly higher than that in control group［96.6%（56/58） vs 81.0%（47/58）］(P=0.006). Before treatment, there was no significant difference of cardiac troponin T, creatine kinase isoenzyme, cardiac troponin I, superoxide dismutase and GSH between groups(P＞0.05). After treatment, cardiac troponin T and cardiac troponin I in observation group were significantly lower than those in control group［（0.764±0.283）U/L vs （1.242±0.442）U/L, （0.752±0.343）μg/L vs （1.521±0.572）μg/L］; creatine kinase isoenzyme, superoxide dismutase and GSH in observation group were significantly higher than those in control group［（30±4）U/L vs （23±3）U/L, （77±8）U/L vs （65±6）U/L, （856±68）U/L vs （659±57）U/L］（all P＜0.05）. Before treatment, there was no significant difference of left ventricular end-systolic diameter, left ventricular end-diastolic diameter and left ventricular ejection fraction between groups(P＞0.05). After treatment, left ventricular end-systolic diameter and left ventricular end-diastolic diameter were significantly lower than those before treatment and left ventricular ejection fraction was significantly higher than that before treatment in both groups; left ventricular end-systolic dimension and left ventricular end-diastolic dimension in observation group were significantly lower than those in control group［（40±7）mm vs （50±8）mm, （51±5）mm vs （60±8）mm］; left ventricular ejection fraction in observation group was significantly higher than that in control group［（74±10）% vs （59±9）%］(all P＜0.05). Incidence rate of adverse reactions in observation group was significantly lower than that in control group［5.2%（3/58） vs 24.1%（14/58）］(P＜0.05). Conclusion    GSH combined with alteplase treating elderly patients with acute myocardial infarction can promote reperfusion, reduce myocardial reperfusion injury, improve heart function and reduce adverse reactions.