左前降支慢血流病人心肌功能改变及尼可地尔的治疗效果  

CHANGES IN MYOCARDIAL FUNCTION IN PATIENTS WITH CORONARY SLOW FLOW IN THE LEFT ANTERIOR DESCENDING CORONARY ARTERY AND THE THERAPEUTIC EFFECT OF NICORANDIL

作　　者：厉宣本 付秀秀[2] 刘永磊 辛辉[1] 陈作元[1] LI Xuanben, FU Xiuxiu, LIU Yonglei, XIN Hui, CHEN Zuoyuan(Department of Cardiology,The Affiliated Hospital of Qingdao University, Qingdao 266003, Chin)

机构地区：[1]青岛大学附属医院心血管内科,山东青岛266003 [2]青岛大学附属医院心脏超声科 [3]潍坊市益都中心医院心内一科

出　　处：《精准医学杂志》2018年第3期234-237,共4页Journal of Precision Medicine

基　　金：山东省自然科学基金项目(ZR2013HM109)

摘　　要：目的研究冠状动脉左前降支(LAD)慢血流(CSF)病人左心室壁节段及整体心肌功能的改变,以及尼可地尔对其心肌节段及整体心肌功能改善作用。方法收集2017年1月—2017年9月因胸痛或胸闷症状行冠状动脉造影检查示CSF的病人36例(CSF组),造影结果正常者36例(对照组),造影后24 h内在二维超声模式下测量两组左心室舒张晚期容积(EDV)、左心室收缩晚期容积(ESV)、左心室射血分数(LVEF)、心搏量(SV)以及二尖瓣血流频谱中舒张早期心室充盈速度最大值(E峰)和舒张晚期心室充盈速度最大值(A峰),并计算E/A比值。运用Tomtec软件采用三维斑点追踪技术测量左心室整体纵向应变(GLS)及仅由LAD供血的左心室的6个室壁节段纵向应变(LS)值;比较CSF组口服尼可地尔(每天3次,每次5 mg)3个月后上述指标的变化,及胸痛或胸闷症状改善情况。结果冠状动脉造影后24 h内两组EDV、ESV、LVEF、S比较,差异无显著性(P>0.05);CSF组与对照组比较E峰降低、A峰升高、E/A比值减小,差异有显著性(P<0.05);与对照组比较,CSF组中仅由LAD供血的左心室的6个室壁节段中有4个节段LS值减小,差异具有显著性(P<0.05);GLS减低,差异具有显著性(P<0.05)。规律应用尼可地尔3个月之后,与治疗前相比,CSF组中77.8%的病人自觉胸痛或胸闷症状完全缓解;E峰升高、E/A比值增大,差异有显著性(P<0.05),A峰差异无显著性(P>0.05);4个节段LS值增大,差异有显著性(P<0.05);GLS值增大,差异有显著性(P<0.05)。结论三维斑点追踪技术较常规超声心动图能更早期发现心肌缺血,在经过尼可地尔规范治疗3个月后CSF组心肌供血明显改善,提示尼可地尔可改善冠状动脉左前降支慢血流病人心肌节段及整体心肌功能。Objective To investigate the changes in the function of the left ventricular wall and the myocardium in patients with coronary slow flow（ CSF） in the left anterior descending coronary artery（ LAD） and the effect of nicorandil in improving the function of the myocardial segments and the myocardium. Methods A total of 36 patients who were found to have CSF bycoronary angiography performed due to chest pain or chest distress from January to September,2017 were enrolled as CSF group,and 36 patients with normal results of coronary angiography were enrolled as control group. Within 24 hours after coronary angiography,two-dimensional ultrasound was performed to measure left ventricularend-diastolic volume（ EDV）,left ventricularend-systolicvolume（ ESV）,left ventricular ejection fraction（ LVEF）,stroke volume（ SV）,mitral peak early diastolic filling velocity（ E peak）,and mitral peak late diastolic filling velocity（ A peak）,and E/A ratio was calculated. With the use of Tomtec software,three-dimensional speckle-tracking imaging was applied to measure the global longitudinal strain（ GLS） values of the left ventricleandthe longitudinal strain（ LS） values of sixventricular wall segments of the left ventricle.The patients in the CSF group were treated with oral nicorandil（ 5 mg/time,three times a day） for 3 months,and then the two groups were compared in terms of the changes in the above indices and the relief of chest pain or chest distress symptom. Results Within 24 hours after coronary angiography,there were no significant differences in EDV,ESV,SV,and LVEF between the CSF group and the control group（ P〈0.05）. Compared with the control group,the CSF group had a significant reduction in E peak,a significant increase in A peak,and a significant reduction in E/A ratio（ P〈0.05）. Compared with the control group,the CSF group had significant reductions in LS values of four ventricular wall segments of the left ventricle（ P〈0.05） and a significant reduction in GLS（ P〈

关 键 词：冠状动脉疾病 冠状动脉循环 血流速度 尼可地尔 心脏功能试验 

分 类 号：R543.3[医药卫生—心血管疾病]