不稳定型心绞痛患者应用曲美他嗪对PCI相关心肌损伤及左心室功能的影响  

Significance of trimetazidine in PCI-related myocardial injury and left ventricular function for unstable angina pectoris patients

作　　者：孙喜文[1] 朱秀龙[1] 陈炎[1] 莫观海[1] 

机构地区：[1]高州市人民医院心内科,高州525200

出　　处：《中华老年多器官疾病杂志》2016年第1期42-46,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的 探讨曲美他嗪对不稳定型心绞痛（UAP）患者经皮冠状动脉介入治疗（PCI）术相关心肌损伤及术后左心室功能的影响。方法 入选2011年1月至2014年1月在高州市人民医院心内科拟行择期PCI术的UAP患者106例，采用随机数字表法分为两组：曲美他嗪组（n＝51）和对照组（n＝55）。曲美他嗪组在常规药物治疗的基础上，于PCI术前0.5～1.0h口服60 mg曲美他嗪（负荷剂量），PCI术后口服常规剂量曲美他嗪（20mg，3次/d）。分别测定PCI术前和术后16～18h患者血清肌钙蛋白I（cTnI）浓度，通过电话随访了两组患者PCI术后的相关情况。结果 PCI术后16～18h时，两组患者的cTnI水平均高于术前（P＜0.05），且两组比较差异有统计学意义（P＜0.05）。与对照组相比，曲美他嗪组患者术后cTnI水平＞0.10μg/L的患者比例较少（P＜0.05）。截至随访结束，曲美他嗪组患者左心室收缩末内径（LVESd）显著低于对照组[（31.00±4.33） vs （33.29±2.11）mm；P＜0.05]，左心室射血分数（LVEF）明显高于对照组[（65.65±3.94）% vs （62.29±3.06）%；P＜0.05]，两组患者主要心血管事件（MACE）发生率差异无统计学意义（7.8% vs 9.1%）。结论 PCI术前口服负荷剂量曲美他嗪可减少手术相关心肌损伤，术后长期服用可改善患者左心室功能。Objective To determine the effect of trimetazidine on myocardial injury related to percutaneous coronary intervention （PCI） and postoperative left ventricular function in the patients with unstable angina pectoris （UAP）. Methods A total of 106 UAP patients undergoing selective PCI in our department from January 2011 to January 2014 were prospectively enrolled in this study. They were randomly assigned into trimetazidine group （n=51） and control group （n=55）. The patients from the former group, besides conventional drug treatment, were given oral administration of 60 mg trimetazidine in 0.5？1.0h before PCI, and of 20mg, 3 times/d after the surgery. The serum concentration of cardiac troponin I （cTnI） was measured before and in 16？18h after PCI. Telephone follow-up was carried out to investigate PCI-related changes. Results The serum cTnI level was significantly higher in 16？18h after than before PCI in the both groups （P〈0.05）, with that of the trimetazidine group elevated more significantly （P〈0.05）. The percentage of the patients with the post-operative cTnI level 〉0.10μg/L was obviously smaller in the trimetazidine group than in the control group （P〈0.05）. Till the end of 12 months’ follow-up, the trimetazidine group had significantly lower left ventricular end systolic dimension [（31.00±4.33） vs （33.29±2.11）mm, P〈0.05）], and obviously higher left ventricular ejection fraction [（65.65±3.94）% vs （62.29±3.06）%, P〈0.01] than the control group, but there was no difference in the incidence of major adverse cardiac event （MACE） between the 2 groups （7.8% vs 9.1%）. Conclusion Pre-operative administration of trimetazidine reduces the PCI-related myocardial injury, and long-term post-operative treatment improves left ventricular function in patients with UAP.

关 键 词：不稳定型心绞痛 曲美他嗪 经皮冠状动脉介入治疗 肌钙蛋白 左心室功能 

分 类 号：R541[医药卫生—心血管疾病]