尼可地尔对急性ST段抬高型心肌梗死患者行急诊经皮冠状动脉介入治疗后室性心律失常的影响  

Effect of nicorandil on ventricular arrhythmia in patients with acute ST-segment elevation myocardial infarction underwent emergent percutaneous coronary intervention treatment

作　　者：王云鹏[1] 张云[1] 孙一荣[1] 孙泽刚[1] 左兆凯[1] 冯泽瑞[1] 常方圆[1] 许迎春[1] 陈保增 叶岩岩[1] 

机构地区：[1]聊城市第二人民医院心内科,252600

出　　处：《中华心血管病杂志》2017年第8期701-705,共5页Chinese Journal of Cardiology

摘　　要：目的 观察尼可地尔对急性ST段抬高型心肌梗死患者行急诊经皮冠状动脉介入治疗（PCI）后室性心律失常的影响.方法 前瞻性纳入2015年1月至2016年6月在聊城市第二人民医院住院的120例急性心肌梗死患者,所有患者采用数字表法分为对照组和尼可地尔组,每组60例,两组均给予常规治疗,术前尼可地尔组服用尼可地尔10 mg,对照组则服用安慰剂.术后尼可地尔组患者继续服用尼可地尔5 mg/次、3次/d,对照组继续服用安慰剂,比较两组患者术后3d的QT间期离散度（QTd）、校正的QT间期离散度（QTcd）以及室性心律失常发生率.结果 尼可地尔组术后6、24、48和72 h的QTd分别为（70.6±4.4）、（67.2±5.3）、（55.7±8.5）和（48.2±8.2） ms,均低于对照组的（77.1±7.1）、（71.3±6.5）、（65.1 ±8.1）和（57.2±5.4） ms（t=13.523、15.376、17.318、20.315,均P ＜0.05）;尼可地尔组术后6、24、48和72 h的QTcd分别为（77.5±7.7）、（67.7±8.6）、（61.2±7.5）和（52.9±8.4） ms,均低于对照组的（88.6±8.1）、（79.2±7.8）、（74.4±7.4）和（69.6±8.6） ms（t=15.397、18.582、20.342、27.352,均P＜0.05）;术中再灌注性心律失常发生率差异无统计学意义,术后3d内尼可地尔组室性早搏发生率为41.7％（25/60）,明显低于对照组的75.0％（45/60,x2=6.52,P＜0.01）;尼可地尔组非持续性室性心动过速及心室颤动发生率为10.0％（6/60）,明显低于对照组的30.0％（18/60,x2=7.42,P＜0.01）.结论 尼可地尔可减少急性心肌梗死患者PCI术后室性心律失常的发生,其机制可能与QTd及QTcd较低有关.Objective To investigate the effect of nicorandil on ventricular arrhythmia in patients with acute ST-segment elevation myocardial infarction （STEMI） treated with emergent percutaneous coronary intervention （PCI）.Methods A total of 120 acute STEMI patients treated with emergent PCI in our hospital from January 2015 to June 2016 were randomly divided into control group and experiment group （n =60 each）.Patients in both groups received conventional therapy.Patients in experiment group took 10 mg nicorandil orally before PCI and received oral nicorandil treatment （15 mg/d,three times daily） for 3 days.QT disperse （QTd）,correct QTd （QTcd） and the occurrence rate of ventricular arrhythmia were compared between two groups.Results QTd at 6,24,48 and 72 hours （（70.6 ± 4.4）,（67.2 ± 5.3）,（55.7 ± 8.5）,（48.2 ± 8.2） ms,respectively） after PCI was significantly lower in the experiment group than those of control group （（77.1 ±7.1）,（71.3 ± 6.5）,（65.1 ± 8.1）,（57.2 ± 5.4） ms,all P 〈 0.05）.The level of QTd was also significantly lower in the experiment group at 6,24,48 and 72 hours （（77.5 ± 7.7）,（67.7 ± 8.6）,（61.2 ± 7.5）,（52.9 ± 8.4） ms,respectively） after PCI c omared to those of control group （（88.6 ± 8.1）,（79.2 ± 7.8）,（74.4 ± 7.4）,（69.6 ± 8.6） ms,all P 〈 0.05）.There was no significant difference in the incidence of reperfusion arrhythmia during PCI procedure between the two groups.The prevalence of the ventricular premature beat in the experiment group （25/60,41.7%） was significantly lower than in the control group （45/60,75.0%） within 3 days after PCI （P 〈 0.01）,the prevalence of the no sustained ventricular tachycardia and ventricular fibrillation in the experiment group （6/60,10.0%） was also significantly lower than in the control group （18/60,30.0%,P 〈0.01） within 3 days after PCI.Conclusions Nicorandil use prior and post PCI could decrease the occurrence rate of ventricular arr

关 键 词：心肌梗死 血管成形术 心律失常 心性 尼可地尔 

分 类 号：R542.22[医药卫生—心血管疾病]