地尔硫䓬和硝普钠改善急性冠脉综合征患者经皮冠状动脉介入治疗中无复流现象的效果评价  

Effects of Diltiazem and Sodium Nitroprusside on Alleviating No-reflow Phenomenon in Patients With Acute Coronary Syndrome During Percutaneous Coronary Intervention

作　　者：陈章强[1] 戴军[2] 姚民[2] 洪浪[1] 王洪[1] 

机构地区：[1]江西省人民医院心内科,江西省南昌市330006 [2]中国医学科学院阜外心血管病医院

出　　处：《中国全科医学》2015年第35期4283-4287,共5页Chinese General Practice

摘　　要：目的比较地尔硫和硝普钠在改善急性冠脉综合征（ACS）患者经皮冠状动脉介入（PCI）治疗中无复流现象的效果。方法选取2008年1月—2014年6月于江西省人民医院接受PCI治疗且术中出现无复流现象的ACS患者80例为研究对象,采用随机数字表法将患者分为地尔硫组（40例）和硝普钠组（40例）。两组于PCI术中经微导管冠状动脉靶病变远端2 s内＂弹丸式＂快速分别给予地尔硫、硝普钠200~600μg,分别于给药后10、20min后复查冠状动脉造影,评价心肌梗死溶栓治疗（TIMI）血流分级和校正的TIMI血流帧数（CTFC）,同时记录给药前及给药后10、20 min有创血压及心率的变化。分别于PCI术前及术后7、30 d记录左心室收缩末内径（LVESD）、左心室舒张末内径（LVEDD）及左心室射血分数（LVEF）。于PCI术前及术后7、30 d测定N末端B型脑钠肽前体（NT-pro BNP）及细胞因子超敏C反应蛋白（hs-CRP）、白介素6（IL-6）及细胞间黏附分子-1（ICAM-1）水平。记录两组术后30 d内主要心血管事件（再发心绞痛、再发急性心肌梗死及心力衰竭发作）和其他心血管事件（恶性心律失常及猝死）的发生情况。结果不同药物对TIMI血流分级、CTFC、收缩压、舒张压及心率的影响比较,差异无统计学意义（P〉0.05）。两组用药后10、20 min TIMI血流分级、CTFC与用药前比较,差异有统计学意义（P〈0.05）。不同药物对LVESD、LVEDD、LVEF的影响比较,差异无统计学意义（P〉0.05）。两组术后30 d LVESD、LVEDD及LVEF与术前比较,差异有统计学意义（P〈0.05）。不同药物对NT-pro BNP、hs-CRP、IL-6及ICAM-1的影响比较,差异无统计学意义（P〉0.05）。两组术后7、30 d NT-pro BNP、hs-CRP、IL-6、ICAM-1水平均低于术前,差异有统计学意义（P〈0.01）。两组术后30 d内主要心血管事件及其他心血管事件发生率比较,差异均无统计学意义（P〉0.05�Objective To make a comparison between diltiazem and sodium nitroprusside in alleviating no-flow phenomenon in patients with acute coronary syndrome（ ACS） during percutaneous coronary intervention（ PCI）. Methods We enrolled 80 ACS patients who had no-flow phenomenon during PCI undertaken in Jiangxi Provincial People＇ s Hospital from January 2008 to June 2014. Using random number table method,the patients were divided into two groups： diltiazem group（ group A,n = 40） and sodium nitroprusside group（ group B,n = 40）. Group A was given diltiazem 200-600 μg by pellet injection from microcatheter selective coronary to far-end target lesions in two seconds,group B was given sodium nitroprusside200-600 μg in the same way. Coronary arteriography was retaken 10 minutes and 20 minutes after administration. Thrombolysis in Myocardial Infarction（ TIMI） flow grade and corrected TIMI frame count（ CTFC） were evaluated. Invasive blood pressure and heart rate were recorded before administration and 10 minutes and 20 minutes after administration. LVESD,LVEDD and LVEF were recorded before PCI and 7 days and 30 days after PCI. The levels of NT-pro BNP,hs-CRP,IL-6 and ICAM-1 were recorded before PCI and 7 days and 30 days after PCI. The incidence rates of major cardiovascular events（ re-angina,re-myocardial infarction and heart failure） and other cardiovascular events（ malignant arrhythmia and sudden death） were recorded.Results The two medicines were not significantly different（ P 0. 05） in the influence on TIMI flow grade,CTFC,systolic pressure,diastolic pressure and heart rate. TIMI flow grade and CTFC of the two groups at 10 minutes and 20 minutes after administration were significantly different from those before administration（ P 0. 05）. The two medicines were not significantly different（ P 0. 05） in the influence on LVESD, LVEDD and LVEF. The levels of LVESD, LVEDD and LVEF of the two groups on 30 days after administration were significantly different from those before administr

关 键 词：急性冠脉综合征 经皮冠状动脉介入治疗 无复流现象 地尔硫䓬 硝普钠 疗效比较研究 

分 类 号：R542.2[医药卫生—心血管疾病]