冠状动脉慢血流患者心肌功能及尼可地尔对其治疗作用的研究  

Assessment of myocardial functions in patients with coronary slow flow and the effects of Nicorandil

作　　者：霍学震 赵雯娜[2] 李姗[1] 董晓楠 付秀秀[4] 陈作元[1] 

机构地区：[1]青岛大学医学院附属医院心血管内科,山东省266003 [2]青岛市第三人民医院心血管内科 [3]青岛市第五人民医院心血管内科 [4]青岛大学医学院附属医院心脏超声科,山东省266003

出　　处：《中华临床医师杂志（电子版）》2013年第23期97-100,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨冠状动脉左前降支(LAD)慢血流(CSF)时左心室壁节段及整体心肌功能的改变,以及尼可地尔对其心肌功能有无改善作用。方法入选因心绞痛症状行冠状动脉造影,造影结果为LAD慢血流的患者36例为慢血流组;造影结果正常者20例为对照组;两组分别于造影后24 h内应用常规超声测量左心室舒张末期内径(LVIDd)、收缩末期内径(LVIDs)、左心室射血分数(LVEF)以及二尖瓣血流频谱中的舒张早期峰值流速(E)和舒张晚期峰值流速(A),并计算E/A比值。应用GE Echo PAC软件采用二维斑点追踪技术测量仅由LAD供血的6个左心室室壁节段收缩期的纵向应变(LS)峰值。慢血流组患者给予尼可地尔5 mg、每日3次治疗90 d后观察胸痛症状改善程度,并再次测量E峰、A峰、E/A比值以及单纯LAD供血节段心肌收缩期的LS峰值。结果造影后24 h内慢血流组与对照组相比LVIDd、LVIDs、LVEF差异无统计学意义,E峰、A峰、E/A等指标差异有统计学意义(P<0.05);单独LAD供血的6个心肌节段中有4个与对照组相比收缩期LS峰值差异有统计学意义(P<0.05),两个节段收缩期LS峰值差异无统计学意义(P>0.05)。尼可地尔治疗3个月后慢血流组中27例胸痛症状有不同程度减轻;慢血流组尼可地尔治疗前后相比E峰、E/A差异有统计学意义(P<0.05),A峰差异无统计学意义(P>0.05);尼可地尔治疗前慢血流组与对照组相比LS峰值差异存在统计学意义中的4个节段与治疗后相比3个心肌节段的LS峰值差异存在统计学意义(P<0.05),1个节段LS峰值差异无统计学意义(P>0.05)。结论 LAD慢血流时常规超声反映其左心室整体舒张功能减退,但整体收缩功能正常;而采用二维斑点追踪技术测量的LS峰值减低表明其单独供血的心肌节段收缩功能已有明显减退;尼可地尔对慢血流患者胸痛症状及心肌功能的改善作用提示其是治疗慢血流的有效药物。Objective To evaluate left ventricular global and regional function in patients with left anterior descending coronary slow flow and effects of Nicorandil. Methods A total of 56 patients underwent coronary angiography for angina were enrolled. Of those 36 with left anterior descending coronary slow flow as CSF group, 20 patients with normal coronary angiography as control group. Left ventricular intemal dimension diastole （LVIDd）, left ventricular intemal dimension systole（LVIDs）, 1eft ventricular ejection fraction（LVEF）, E peak, A peak and E/A ratio were assessed using routine heart Doppler ultrasonic. Longitudinal Strain（LS） of the six segments supplied only by left anterior descending artery regional were assessed using two dimensional speckle tracking imaging.All quotas of the CSF group were assessed after treatment with Nicorandil 5 mg three times a day. Results There was no significant difference in LVIDd, LVIDs and LVEF between the CSF group and the control group. Compared with the control group, the CSF group＆#39;s E peak,E/A ratio decreased and A peak increased. Ls in four of the six segments that single supplied by LAD decreased. Treatment with Nicorandil alleviate the angina of 27 patients of the CSF group in vary degrees and significantly increased E peak and E/A ratio. Three of the four segments＆#39; Ls has significant difference and one of the four Segments＆#39; Ls has no significant difference after treatment. Conclusion Routine heart Doppler ultrasonic suggests that 1eft ventricular global diastolic function impaired and global systolic function not affected in patients with coronary slow flow. Two dimensional speckle tracking imaging suggest that regional systolic function has impaired in patients with coronary slow flow. Nicorandil maybe a effective drug for improve CSF patients＆#39; myocardial function and alleviate the angina symptom.

关 键 词：冠状血管 尼可地尔 心室功能 慢血流 斑点追踪 

分 类 号：R541.4[医药卫生—心血管疾病]