Peri-procedural myocardial injury impact of allopurinol pretreatment in patients with undergoing PCI
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摘要: 目的:探讨别嘌醇预处理对经皮冠状动脉介入 (PCI) 治疗患者围手术期心肌损伤的保护作用。方法:选取246例拟择期行PCI的患者, 随机分为试验组 (124例) 和对照组 (122例), 两组患者均予以冠心病标准化药物治疗, 试验组在标准化药物治疗基础上给予别嘌醇顿服300mg/d (术前至少连续口服3d), 术后100mg/d维持。术后824h测定肌酸激酶同工酶 (CK-MB)、肌钙蛋白T (cTnT)、C反应蛋白 (CRP)、肝功能、肾功能、血常规。结果:试验组PCI术后CK-MB和cTnT超过正常上限的发生率分别为6.5%和10.5%, 显著低于对照组的发生率21.3%和38.5% (均P<0.05)。试验组PCI术后CRP超过正常上限的发生率为11.3%, 低于对照组的发生率23.0% (P<0.05)。试验组别嘌醇治疗期间有1例患者因皮疹而退出, 余治疗结束时肝功能、肾功能、血细胞情况等均无明显改变, 未发现明显严重不良反应。结论:300mg/d常规剂量别嘌醇预处理可显著减少择期PCI患者围手术期心肌损伤。
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关键词:
- 经皮冠状动脉介入治疗术 /
- 别嘌醇 /
- 围手术期心肌损伤
Abstract: Objective: To investigate potential protective effects of allopurinol pretreatment in patients with undergoing elective percutaneous coronary intervention (PCI).Method: A total of 246patients with undergoing elective PCI were randomized to pretreatment with allopurinol (300mg/d at least 3days before the procedure.n=124, with a maintenance dosage 100mg/d after PCI), or placebo (n=122).All patients without contraindications were pretreated standard medical therapy.Creatine kinase-MB (CK-MB), troponin T (cTnT), C-reactive protein (CRP) levels, and liver function, renal function and routine blood test were measured at baseline and at 8to 24 hours after the procedure.Result: The primary end point occurred in the proportion of patients of postoperative CKMB over upper limits of normal, and cTnT positive in experimental group were 6.5%and 10.5%, lower than that in control group 21.3%and 38.5% (both P<0.05).The secondary end points of the rise of postoperative CRP levels in experimental group was 11.3%, lower than that in control group 23.0% (P<0.05).There were no cytopenia, dermatitis, abnormal liver function or renal dysfunction in experimental group, but only one drop out because of rash reaction until the end of treatment.Conclusion: Taking allopurinol (300 mg/d) pretreatment in patients with undergoing elective PCI is effective, and may reduce incidence of postoperative myocardial damage. -
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