尼可地尔联合曲美他嗪对改善老年急性心肌梗死急性PCI术后心功能的作用  

Effect of nicorandil combined with trimetazidine on improving cardiac function in elderly AMI patients with emergency PCI

作　　者：韩孝宇[1] 安建立[1] 王文广[1] 杨红梅[1] 张晶[1] 王庆胜[1] 代玉涵 刘晓媛[1] HAN Xiao-yu;AN Jian-li;WANG Wen-guang;YANG Hong-mei;ZHANG Jing;WANG Qing-sheng;DAI Yu-ban;LIU Xiao-yuan(The First Hospital of Qinhuangdao City,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第一医院,秦皇岛066000

出　　处：《内科急危重症杂志》2018年第6期467-471,共5页Journal of Critical Care In Internal Medicine

基　　金：秦皇岛市重点研发计划科技支撑项目(No:201703A083)

摘　　要：目的:观察急诊经皮冠状动脉介入术(PCI)后联合口服尼可地尔和曲美他嗪对老年多支病变ST段抬高型心肌梗死(STEMI)患者心功能的改善效果。方法:将105例急诊PCI患者根据随机数字表法分为联合组(52例)和曲美他嗪组(53例)。曲美他嗪组出院后服用盐酸曲美他嗪片,联合组在曲美他嗪组基础上加服尼可地尔片。观察2组血清学标志物、顿抑心肌血流灌注、心功能及不良心血管事件的发生情况。结果:术后6个月,2组血清B型脑钠肽(BNP)、高敏C反应蛋白(hs-CRP)、金属基质蛋白酶-9(MMP-9)水平显著低于术后3个月水平(均P <0. 05);术后3个月,联合组血BNP水平显著低于曲美他嗪组(P <0. 05),术后6个月联合组血BNP、hs-CRP、MMP-9水平显著低于曲美他嗪组(均P <0. 05)。心肌核素显像显示术后6个月2组静息灌注总积分(SRS)、总灌注缺损面积百分比(TPD%)显著低于术后3个月水平(均P <0. 05);术后3个月,联合组SRS显著低于曲美他嗪组,术后6个月,联合组SRS、TPD%显著低于曲美他嗪组(均P <0. 05)。超声心动图显示2组术后左室射血分数(LVEF)、峰射血率(PER)较出院前显著提高(均P <0. 05),左室收缩末期容积指数(LVESVI)、左室舒张末期容积指数(LVEDVI)显著降低(均P <0. 05);术后3个月,联合组LVEF显著高于曲美他嗪组,术后6个月,联合组LVEF、PER显著高于曲美他嗪组(均P <0. 05),而LVESVI、LVEDVI显著低于曲美他嗪组水平(均P <0. 05)。联合组随访期内心绞痛发生率(7. 7%vs 17. 0%)、靶血管血运重建率(1. 9%vs 5. 7%)、再入院率(5. 8%vs 9. 4%)低于曲美他嗪组(均P>0. 05)。结论:急诊PCI术后口服曲美他嗪基础上加服尼可地尔有助于减轻心肌损伤,提高心功能。Objective: To observe the efficacy of nicorandil combined with trimetazidine in the improvement of cardiac function in elderly ST elevation myocardial infarction(STEMI) patients with emergency percutaneous coronary intervention(PCI). Methods: 105 cases undergoing emergency PCI were randomly divided into combined group(52 cases) and trimetazidine group(53 cases). The trimetazidine group was given trimetazidine tablets after discharge. The combined group was added with nicorandil tablet. Serological markers of myocardial injury and improvement of hibernating myocardial perfusion,cardiac function and adverse cardiovascular events were observed. Results: The brain natriuretic peptide(BNP),high sensitive C-reactive protein(CRP) and matrix metalloproteinases-9(MMP-9) levels at 6th month postoperation were significantly lower than those at 3rd month postoperation in both groups(P < 0. 05). At 3rd month after operation,BNP level was significantly lower in the combined group than in the trimetazidine group(P < 0. 05). At 6th month after operation,BNP,hs-CRP and MMP-9 levels were significantly lower in the combined group than in the trimetazidine group(P < 0. 05). Myocardial perfusion imaging showed summed rest score(SRS) and total perfusion defect(TPD%) at 6th month postoperation were significantly lower than those at 3rd month postoperation in both groups(P < 0. 05). At 3rd month after operation,SRS was significantly lower,and at 6th month after operation,SRS and TPD% were significantly lower in the combined group than in the trimetazidine group(both P < 0. 05). Echocardiography showed left ventricular ejection fraction(LVEF) and peak ejec tion rate(PER) were significantly higher(P < 0. 05),and left ventricular end systolic volume index(LVESVI) and left ventricular end diastolic volume index(LVEDVI) were significantly lower(P < 0. 05) after operation than before discharge in both groups. At 3rd month after operation,LVEF was significantly higher in the combined group than in the trimetazidine group. At 6th month after op

关 键 词：急诊经皮冠状动脉介入术 ST段抬高型心肌梗死 尼可地尔 曲美他嗪 心肌灌注 心功能 

分 类 号：R542.22[医药卫生—心血管疾病]