尼可地尔对急性ST段抬高型心肌梗死急诊经皮冠状动脉介入治疗术后近期及远期预后的影响:Meta分析  

Impact of nicorandil on acute and long-term prognosis in patients with acute myocardial infarction undergoing percutaneous coronary intervention: Meta-analysis

作　　者：罗义波 王扬淦[1] 丁进叶 周游[1] 

机构地区：[1]武汉大学中南医院心内科,430071

出　　处：《中华临床医师杂志（电子版）》2015年第15期82-87,共6页Chinese Journal of Clinicians(Electronic Edition)

基　　金：国家自然科学基金面上项目(81270304);国家自然科学基金重大项目(81420108004)

摘　　要：目的评价尼可地尔对行急诊经皮冠状动脉介入治疗(PCI)术的急性ST段抬高型心肌梗死患者术后近期及远期预后的影响。方法检索Cochrane图书馆、Pubmed、中国知网、万方等数据库自建库以来至2014年5月公开发表的急性ST段抬高型心肌梗死在急诊PCI术围手术期给予尼可地尔作为辅助药物治疗相关的随机临床对照试验,并手工检索纳入的参考文献。完成质量评价,采用Review manager 5.0软件对纳入的试验结果进行统计学分析。结果最终14项随机对照试验,共计1 930例患者纳入此项分析。结果显示尼可地尔显著降低ST段抬高型心肌梗死患者急诊PCI术后的TIMI血流分级≤2的人数(RR:0.49;95%CI:0.36~0.65),校正TIMI帧数(CTFC)(MD:-5.40;95%CI:-7.18^-3.68),以及再灌注心律失常的发生率(RR:0.54;95%CI:0.37~0.78),有效提高术后6个月内心脏射血分数(MD:5.98;95%CI:3.53~8.43)。同时尼可地尔能降低包括心源性死亡及因慢性心力衰竭入院的终点事件的发生率(RR:0.42;95%CI:0.29~0.59),对心肌酶峰值的影响无统计学差异(MD:-115.94;95%CI:-353.77~121.90)。结论急性ST段抬高型心肌梗死患者行急诊PCI术前给予尼可地尔可以提高冠状动脉血流灌注,降低再灌注心律失常发生率,并提高左心室射血分数,改善近期预后。同时降低包括心源性死亡,因充血性心力衰竭住院等主要终点事件发生率,改善远期预后。ObjectiveTo evaluate the acute and long-term effect of nicorandil on patients with acute ST segment elevation myocardial infarction （ASTEMI） undergoing percutaneous coronary intervention （PCI）.MethodsWe searched the published data relevant to randomized controled trials （RCTs） comparing treatment with nicorandil prior to reperfusion therapy with controls （placebo or no nicorandil） in patients with AMI undergoing primary PCI from the data source of PubMed, Cochrane Library, CNKI, WANGFANG, and VIP databases up to May. 2014. After quality assessment, al included RCTs were analyzed by Review Manger 5.1 software.Results14 trials involving 1 930 patients were included into this Meta-analysis. The results showed that Nicorandil significantly reduced the incidence of TIMI flow grade less than 2 （RR： 0.49; 95%CI： 0.36-0.65） and the corrected TIMI Frame Count （CTFC） mean difference（MD：-5.40; 95%CI：-7.18--3.68）, reduced the incidence of reperfusion arrhythmia （RR： 0.54; 95%CI： 0.37-0.78） and enhanced left ventricular ejection fraction （LVEF）（%） within 6 months （MD： 5.98; 95%CI： 3.53-8.43）, reduced the incidence of the primary end point events （including cardiovascular death and unplanned hospital admission of congestive heart-failure（CHF）（RR： 0.42; 95%CI： 0.29-0.59）.Nicorandil did not change the peak creatine kinase （CK） level （MD：-115.94; 95%CI：-353.77-121.90）. ConclusionsNicorandil administration prior to reperfusion is helpful for the improvement of coronary reflow and inhibition of reperfusion arrhythmias. It improves left ventricular function in AMI patients treated with primary PCI. Moreover, Nicorandil reduces the incidence of the primary end point events and improves the long-term prognosis.

关 键 词：尼可地尔 心肌梗死 血管成形术 经腔 经皮冠状动脉 

分 类 号：R542.22[医药卫生—心血管疾病]