目的 探討烏司他丁聯(lián)合環(huán)磷腺苷葡胺治療急性心肌梗死的臨床療效。方法 選取2016年6月—2017年6月在哈爾濱醫(yī)科大學(xué)附屬第二醫(yī)院進(jìn)行治療的急性心肌梗死患者74例，隨機(jī)分為對(duì)照組（37例）和治療組（37例）。對(duì)照組患者靜脈滴注注射用環(huán)磷腺苷葡胺，180 mg加入5%葡萄糖注射液250 mL，1次/d。治療組在對(duì)照組的基礎(chǔ)上靜脈滴注烏司他丁注射液，100 000 U加入5%葡萄糖注射液500 mL，每次持續(xù)1～2 h，2次/d。兩組患者均經(jīng)過(guò)2周治療。觀察兩組患者臨床療效和心電圖療效，比較治療前后兩組患者心絞痛發(fā)作次數(shù)、心絞痛持續(xù)時(shí)間、心功能指標(biāo)、血清學(xué)指標(biāo)和神經(jīng)內(nèi)分泌激素水平。結(jié)果 治療后，對(duì)照組和治療組臨床總有效率分別為81.08%和94.59%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，對(duì)照組和治療組心電圖有效率分別為70.27%和91.89%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者心絞痛發(fā)作次數(shù)和持續(xù)時(shí)間均顯著減少（P<0.05）；且治療組患者心絞痛發(fā)作次數(shù)和持續(xù)時(shí)間顯著少于對(duì)照組（P<0.05）。治療后，兩組每博量（SV）、心博量（CO）、左心室射血分?jǐn)?shù)（LVEF）水平均明顯升高（P<0.05）；且治療組患者心功能指標(biāo)明顯高于對(duì)照組（P<0.05）。治療后，兩組血清患者C反應(yīng)蛋白（hs-CRP）、心肌肌鈣蛋白（cTnI）、磷酸肌酸激酶（CK）和氨基末端腦鈉肽前體（NT-proBNP）水平均顯著降低（P<0.05）；且治療組患者上述血清學(xué)指標(biāo)明顯低于對(duì)照組（P<0.05）。治療后，兩組患者血清去甲腎上腺素（NE）、腎素活性（PRA）、β內(nèi)啡肽（β-EP）、血管緊張素Ⅱ（Ang Ⅱ）水平均顯著降低（P<0.05）；且治療組患者的神經(jīng)內(nèi)分泌激素水平顯著低于對(duì)照組（P<0.05）。結(jié)論 烏司他丁聯(lián)合環(huán)磷腺苷葡胺治療急性心肌梗死可有效改善患者心功能，保護(hù)受損心肌細(xì)胞，降低機(jī)體炎癥反應(yīng)和神經(jīng)內(nèi)分泌激素水平。

Objective To explore the clinical efficacy of ulinastatin combined with meglumine adenosine cyclophosphate in treatment of acute myocardial infarction. Methods Patients (74 cases) with acute myocardial infarction in the 2nd Affiliated Hospital of Harbin Medical University from June 2016 to June 2017 were randomly divided into control (37 cases) and treatment (37 cases) groups. Patients in the control group were iv administered with Meglumine Adenosine Cyclophosphate for injection, 180 mg added into 5% Glucose Injection 250 mL, once daily. Patients in the treatment group were iv administered with Ulinastatin Injection on the basis of the control group for 1-2 h, 1×10⁵ U added into 5% Glucose Injection 500 mL, twice daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacy and ECG efficacy were evaluated, the frequency and duration of angina attack, cardiac function indexes, serological indexes, and neuroendocrine hormones in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 81.08% and 94.59%, respectively, and there were differences between two groups (P < 0.05). After treatment, the ECG efficacy in the control and treatment groups were 70.27% and 91.89%, respectively, and there were differences between two groups (P < 0.05). After treatment, the frequency and duration of angina attack in two groups were significantly decreased (P < 0.05). And the frequency and duration of angina attack in the treatment group were significantly less than that in the control group (P < 0.05). After treatment, the SV, CO, and LVEF levels in two groups were significantly increased (P < 0.05). And the cardiac function indexes in the treatment group were significantly higher than those in the control group (P < 0.05). After treatment, the hs-CRP, cTnI, CK and NT-proBNP levels in two groups were significantly decreased (P < 0.05). And the serological indexes levels in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the NE, PRA, β-EP and Ang Ⅱ levels in two groups were significantly decreased (P < 0.05). And the neuroendocrine hormones levels in the treatment group were significantly lower than those in the control group (P < 0.05). Conclusion Ulinastatin combined with meglumine adenosine cyclophosphate can effectively improve the cardiac function and protect the damaged myocardial cell in treatment of acute myocardial infarction, which also reduce the inflammatory response and neuroendocrine hormone levels.