曲美他嗪联合远端缺血预处理对行PCI治疗的老年缺血性心脏病患者心肌损伤及预后的影响  

Effect of trimetazidine combined with remote ischemic preconditioning on myocardial damage and prognosis in elderly ischemic heart disease patients after percutaneous coronary intervention

作　　者：王品晓[1] 张云霞[1] 孙腾飞[1] 乔建洪[2] WANG Pin-xiao ZHANG Yun- xia SUN Teng-fei et al(Department of Cardiology, Wenzhou TCM Hospital, Wenzhou, Zhefiang 325000, Chin)

机构地区：[1]温州市中医院心血管内科,浙江温州325000 [2]温州医科大学附属第二医院心内科,浙江温州325000

出　　处：《中华全科医学》2017年第10期1697-1699,共3页Chinese Journal of General Practice

基　　金：浙江省温州市科技计划项目(Y20160116)

摘　　要：目的探讨曲美他嗪联合远端缺血预处理对行经皮冠状动脉介入治疗(PCI)的老年缺血性心脏病患者心肌损伤及预后的影响。方法选取2016年1月—2016年9月于温州市中医院及温州医科大学附属第二医院行PCI的老年缺血性心脏病患者96例,随机对照表法分为观察组和对照组,各48例。2组患者均行抗血小板等常规药物治疗,对照组在此基础上加用曲美他嗪进行治疗,观察组在此基础上,联合应用曲美他嗪和远端缺血预处理。观察2组患者治疗前及治疗24 h后心肌损伤指标肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)变化及随访6个月不良心血管事件的发生情况。结果与治疗前相比,2组患者治疗24 h后心肌损伤指标cTnI、CK-MB均明显升高(P<0.05),但对照组cTnI、CK-MB升高更显著(P<0.05);随访6个月,观察组再发心绞痛者2例,再发心绞痛发生率为4.17%,心肌梗死0例,死亡0例,对照组再发心绞痛者10例,再发心绞痛发生率为20.83%,心肌梗死者5例,心肌梗死发生率为10.42%,死亡0例。观察组再发心绞痛发生率、心肌梗死发生率均明显低于对照组(P<0.05)。结论曲美他嗪联合远端缺血预处理应用于行PCI治疗的老年缺血性心脏病患者中,可明显降低cTnI、CK-MB水平,减少心肌损伤及不良心血管事件的发生。Objective To investigate the effect of trimetazidine combined with remote ischemic preconditioning（RIPC） on myocardial damage and prognosis in elderly ischemic heart disease patients undergoing percutaneous coronary intervention （PCI）. Methods A total of 96 elderly ischemic heart disease patients treated with PCI were randomly divided into ob- servation group（48 cases） and control group（48 cases） from January,2016 to September,2016. All the patients of 3 groups received antiplatelet routine drug treatment, etc. The control group received additional trimetazidine therapy, while the observation group received additional trimetazidine and RIPC. The changes of cTnI and CK-MB before and after the treatment and the incidence of adverse cardiovascular events at follow-up of 6 months were observed in both groups. Re- suits The levels of cTnI and CK-MB increased significantly in both groups at 24 h after treatment （ P 〈 0.05 ）, the levels of cTnI and CK-MB of the observation group was significantly lower than that at 24 h after the treatment （ P 〈 0.05 ） ; 6 months follow-up showed that there were 2 cases of recurrent angina in the observation group, with an incidence of 4.17% ;there were no myocardial infarction and death cases ;while there were 10 cases of recurrent angina in the control group with an incidence of 20.83% , there were 5 case of myocardial infarction with an incidence of 10.42% , there was no death case. The incidence of recurrent angina and myocardial infarction of the observation group was significantly lower than that in the control group （ P 〈 0.05 ）. Conclusion Trimetazidine combined with remote ischemic preconditioning in elderly ischemic heart disease patients after PCI can obviously reduce the levels of cTnI and CK-MB, reduce the myocardi- al damage and incidence of adverse cardiovascular events.

关 键 词：曲美他嗪 远端缺血预处理 缺血性心脏病 经皮冠状动脉介入治疗 心肌损伤 预后 

分 类 号：R541[医药卫生—心血管疾病] R542.2[医药卫生—内科学]