远端保护装置治疗老年急性ST 段抬高型心肌梗死心肌标志物 变化的研究

目的:探讨应用远端保护装置GuardWire PlusTM治疗老年急性ST段抬高型心肌梗死(STEMI)对外周血肌钙蛋白(cTnI)、肌酸激酶同工酶(CK-MB)的影响。方法:将2004年9月至2009年12月在我院行急诊PCI的60例年龄>60岁老年STEMI患者分为远端保护组(GW)和非远端保护组(NGW)。于术前、术后4h、8h、12h、16h、24h、2d、3d、5d分别测定外周血cTnI、CK-MB水平,并比较两组间变化及其峰值水平。结果:两组全部病例均成功植入支架。GW组全部成功放置GuardWire PlusTM远端保护装置。发病后12h两组CK-MB的值有明显差别(P<0.05),并且GW组出现酶峰提前,发病后6h、12h两组的CTNI的值有明显差别(P<0.05),并且GW组出现峰值提前。结论:老年心肌梗死急诊PCI中应用远端保护装置可以缩小梗死面积,改善预后。

Study on Cardiac InjuryMarkers Change in the Elderly Patients with ST Segment Elevation in Acute Myocardial Infarction Using Distal Protection Device

Objective: To study the changes in cTnI、CK-MB in the elderly patients with ST segment elevation in acute myocardial infarction using distal protection device(GuardWire PlusTM).Methods: Sixty STEMI elderly patients who received percutaneous coro-nary intervention(PCI) during September 2004 to December 2009 were enrolled in the study.All the patients were divided into 2 groups which were: the distal protection device group(GW group n=30) and the non-distal protection device group(NGW group n=30)accord-ing to whether distal protection device was applied or not.The cTnI and CK-MB levels were measured on the day of operation and at 4,8,12,16 and 24 hours after the operation,as well as on 2,3,and 5 days after wards.Results: The levels of CK-MB showed a rapid de-cline in their plasma levels in the GW group compared with the NGW group on 12h after the operation(P<0.05).The peak level of CK-MB of GW group showed up earlier compared with the NGW group.The levels of cTnI showed a rapid decline in their plasma levels in the GW group compared with the NGW group on 6h and 12h after the operation(P<0.05).The peak level of cTnI of GW group showed up earlier compared with the NGW group.Conclusion: In the elderly patients with ST segment elevation in acute myocardial in-farction using distal protection device can minimize myocardial damage.