尼可地尔在急性前壁心肌梗死患者中的药物后适应作用  

Postconditioning effects of oral nicorandil treatment on patients with acute anterior myocardial infarction

作　　者：刘通[1,2] 冯力[1,2] 袁勇[1,2] 董剑廷[1,2] 罗冬云[1,2] 李飞[1,2] 劳翼[1,2] 

机构地区：[1]中山大学附属中山医院 [2]中山市人民医院心内科,广东中山528400

出　　处：《临床心血管病杂志》2014年第11期976-979,共4页Journal of Clinical Cardiology

摘　　要：目的:探讨尼可地尔是否能通过模拟缺血后适应效应来减少急性前壁ST段抬高心肌梗死患者的心肌梗死面积。方法:急性前壁心肌梗死的患者随机分为两组,尼可地尔组(NIC组,21例)及消心痛组(ISDN组,22例)。NIC组患者在行PCI术前服用10mg尼可地尔,而ISDN组服用10mg硝酸异山梨酯。2组患者均在PCI前及PCI后8、16、24、48、72h测定血清肌酸激酶同工酶(CK-MB)浓度,术后7d行ECT心肌灌注显像。结果:尼可地尔能显著减少心肌梗死后的CK-MB峰值[NIC组(171.6±105.7)U/L,ISDN组(246.4±108.4)U/L,P<0.05],并能减少CK-MB曲线下面积[NIC组(4 309±2 575),ISDN组(5 854±2 352),P<0.05],改善ECT心肌灌注缺损面积占左室的百分比[NIC组(30.38±11.83)%,ISDN组(38.64±14.59)%,P<0.05],且NIC组ECT心肌灌注缺损评分优于ISDN组[NIC组(25.19±11.96),ISDN组(33.27±14.03),P<0.05]。结论:尼可地尔可以通过激活心肌细胞线粒体K-ATP通道,模拟药物后适应效应,从而减少心肌梗死面积。Objective：To test whether Nicorandil can induce pharmacologic postconditioning to achieve the result of reducing the infarct size of the acute anterior myocardial infarction.Method：Patients with acute anterior ST-segment elevation myocardial infarction were enrolled and randomly divided into group Nicorandil and group ISDN.The 21 patients in Nicorandil group were taken 10 mg Nicorandil orally before PCI procedure,and 22 patients in ISDN group were given Isosorbide Dinitrate（ISDN）in the same method.The blood samples were taken before operation and 8,16,24,48,72 hafter operation.At last,the ECT myocardial perfusion examinations were performed on the 7th day after operation.Result：Compared with the ISDN,Nicorandil can considerably reduce the peak value of creatine kinase myocardial band.NICORANDIL group（171.6±105.7）U/L vs ISDN group（246.4±108.4）U/L,P〈0.05.They can also reduce the area under the curve.NICORANDIL group（4309±2575）vs ISDN group（5854±2352）,P〈0.05.In addition,Nicorandil can reduce the proportion of ECT myocardial pefusion defect extent in left ventricle：NICORANDIL Group（30.38 ±11.83）% vs ISDN group（38.64±14.59）%,P〈0.05.And ECT perfusion defect score is：NICORANDIL Group（25.19±11.96）vs ISDN group（33.27±14.03）,P〈0.05.Conclusion：By activating the mito-KATP channel,Nicorandil can induce pharmacologic postconditioning effect,limit the infarct size of the acute anterior myocardial infarction,eventually form cardioprotective effects.

关 键 词：缺血后适应 尼可地尔 急性前壁心肌梗死 线粒体ATP敏感性钾离子通道 

分 类 号：R542.2[医药卫生—心血管疾病]