尼可地尔对急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入术后临床效果的影响  

The effects of nicorandil on clinical outcome after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

作　　者：皮淑芳[1] 刘迎午[1] 李彤[1] 王禹[1] 刘博江[1] 李鑫[1] 彭文近[1] 王赟赟[1] 黄雷[1] PI Shu-fang;LIU Ying-wu;LI Tong;WANG Yu;LIU Bo-jiang;LI Xin;PENG Wen-jin;WANG Yun-yun;HUANG Lei(Department of Heart Center,Tianjin Third Central Hospital,Tianjin Institute of Hepatobiliary Disease,Tianjin Key Laboratory of Artificial Cell,Artificial Cell Engineering Technology Research Center of Public Health Ministry,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院心脏中心,天津市肝胆疾病研究所,天津市人工细胞重点实验室,卫生部人工细胞工程技术研究中心,300170

出　　处：《天津医药》2018年第7期724-728,共5页Tianjin Medical Journal

摘　　要：目的观察冠状动脉联合外周静脉应用尼可地尔对急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入(PPCI)治疗术后心肌微循环及短期预后的影响。方法 100例接受PPCI治疗的急性STEMI患者,根据不同给药方式分为尼可地尔组和对照组,每组各50例。尼可地尔组于PPCI术中开通靶血管即刻予冠状动脉注射尼可地尔并静脉持续泵入24 h,对照组于PPCI术中予冠脉注射生理盐水并静脉持续泵入24 h。主要观察指标为PPCI术后即刻冠脉血流及心肌血流灌注情况,包括介入术后TIMI血流分级、校正TIMI帧计数(CTFC)、再灌注心律失常、ST段回落、肌酸激酶同工酶(CK-MB)达峰时间及峰值,次要观察指标为住院期间主要不良心血管事件(MACE)及左心室射血分数(LVEF)。结果 2组内手术前后肝肾功能、心率、血压变化差异无统计学意义(均P>0.05)。与对照组相比,PPCI术后尼可地尔组再灌注心律失常发生比例、慢血流/无复流比例、住院期间MACE比例、CTFC、CK-MB峰值降低;TIMI 3级血流患者比例、CK-MB达峰时间提前至14 h内的比例、ST段回落的比例均明显增加(均P<0.05)。2组患者住院期间LVEF差异无统计学意义(P>0.05)。结论冠脉联合外周静脉应用尼可地尔有助于实现STEMI患者PPCI术后梗死血管的血运重建,减少慢血流/无复流的发生,限制梗死面积,增加心肌血流灌注,改善心肌微循环和短期预后。Objective To evaluate the effects of combined intracoronary and intravenous administration of nicorandil on myocardial microcirculation and short-term prognosis in patients with acute ST-segment elevation myocardial infarction(STEMI)treated with primary percutaneous coronary intervention(PPCI).Methods A total of 100 patients with acute STEMI underwent PPCI were randomly divided into the nicorandil group(patients received intracoronary bolus injection of nicorandil when the target vessel opened and then continuous intravenous infusion within 24 hours,n=50)and the control group(patients received normal saline as control,n=50).The main outcome measures were immediate coronary flow and myocardial perfusion after PPCI,including thrombo-Lysis in myocardial infarction(TIMI)flow grade,corrected TIMI frame count(CTFC),reperfusion arrhythmia,ST-segment resolution,plasma creatine kinase isoenzyme(CK-MB)peak value and time.The secondary indicators were major adverse cardiovascular events(MACE)and left ventricular ejection fraction(LVEF)during hospitalization.Results There were no significant differences in hepatorenal function,heart rate and blood pressure before and after operation in each group(P>0.05).The incidence of reperfusion arrhythmia,the level of MACE,CTFC,and peak value of CK-MB were all significantly lower in the nicorandil group compared with those of control group(P<0.05).The proportions of patients with TIMI 3 flow,CK-MB peak time in 14 hours,and the proportion of ST-segment resolution were significantly higher in the nicorandil group than those of the control group(all P<0.05).There was no significant difference in LVEF during hospitalization between two groups(P>0.05).Conclusion Intracoronary and intravenous administration of nicorandil can significantly improve revascularization effects,reduce the occurrence of slow flow/no reflow,limit myocardial infarction size,increase myocardial perfusion and improve myocardial microcirculation and the short-term prognosis of acute STEMI patients.

关 键 词：尼可地尔 心肌梗死 血管成形术 经腔 经皮冠状动脉 心肌再灌注 预后 急性ST段抬高型心肌梗死 

分 类 号：R542.22[医药卫生—心血管疾病] R972.4[医药卫生—内科学]