尼可地尔对ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后无复流现象、心肌再灌注损伤及心功能的影响研究  

Effects of Nicorandil on No-reflow Phenomenon,Myocardial Reperfusion Injury and Cardiac Function in Patients with ST-segment Elevation Myocardial Infarction after Percutaneous Coronary Intervention

作　　者：刘珊珊 李敬 饶芳 周怡 李治纲 LIU Shan-shan;LI Jing;RAO Fang;ZHOU Yi;LI Zhi-gang(Department of Pharmacy,the Second People's Hospital of Kashgar Prefecture,Kashgar 844000,China;Department of Cardiology,the Second People's Hospital of Kashgar Prefecture,Kashgar 844000,China;Department of Medical Administration,the Second people's Hospital of Kashgar Prefecture,Kashgar 844000,China)

机构地区：[1]新疆维吾尔自治区喀什地区第二人民医院药学部,844000 [2]新疆维吾尔自治区喀什地区第二人民医院心内科,844000 [3]新疆维吾尔自治区喀什地区第二人民医院医务部,844000

出　　处：《实用心脑肺血管病杂志》2018年第9期15-19,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：新疆维吾尔自治区自然科学基金资助项目(2016D01C102)

摘　　要：目的探究尼可地尔对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后无复流现象(NRP)、心肌再灌注损伤及心功能的影响。方法选取2015年2月—2017年4月喀什地区第二人民医院收治的STEMI患者84例,采用随机数字表法分为对照组和尼可地尔组,每组42例。对照组患者行常规PCI;尼可地尔组患者在对照组基础上经导管向罪犯血管缓慢推注尼可地尔6 mg,术毕以2 mg/h速度静脉泵注12 h。比较两组患者手术情况,术前及术后6、12、24 h心肌再灌注损伤指标[包括血清心肌肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)水平],术前及术后6个月左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD),术前及术后7 d、1个月、3个月血清N末端脑钠肽前体(NT-proBNP)水平;并记录两组患者术后12个月内主要不良心血管事件(MACE)发生情况。结果 (1)两组患者支架植入数量、病变血管支数及术后冠状动脉痉挛发生率比较,差异无统计学意义(P>0.05);尼可地尔组患者术后TIMI血流分级优于对照组,术后NRP发生率低于对照组(P<0.05)。(2)时间与方法在血清cTnI、CK-MB水平上存在交互作用(P<0.05);时间在血清cTnI、CK-MB水平上主效应显著(P<0.05);方法在血清cTnI、CK-MB水平上主效应显著(P<0.05)。尼可地尔组患者术后6、12、24 h血清cTnI、CK-MB水平低于对照组(P<0.05)。(3)术前两组患者LVEF和LVEDD比较,差异无统计学意义(P>0.05);术后6个月,尼可地尔组患者LVEF高于对照组,LVEDD短于对照组(P<0.05)。时间与方法在血清NT-proBNP水平上不存在交互作用(P>0.05);时间在血清NT-proBNP水平上主效应显著(P<0.05);方法在血清NT-proBNP水平上主效应显著(P<0.05)。尼可地尔组患者术后7 d、1个月、3个月血清NT-proBNP水平低于对照组(P<0.05)。(4)术后12个月内,尼可地尔组患者MACE发生风险低于对照组[HR=0.370,95%CI(0.143,0.958),P<0.05]。结论尼可地尔能有效改善STEMI患者PObjective To investigate the effect of nicorandil on no reflow phenomenon(NRP),myocardial reperfusion injury and cardiac function in patients with ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods A total of 84 patients with STEMI admitted to the Second People's Hospital of Kashgar Prefecture from February 2015 to April 2017 were selected,and they were divided into control group(n=42)and nicorandil group(n=42)by random number table method.Both control group and nicorandil group were treated with conventional PCI,while patients in nicorandil group were given additional 6 mg of nicorandil slowly through catheter into culprit vessel,and were given intravenous infusion of nicorandil at a rate of 2 mg/h for 12 hours after operation.PCI operation,myocardial reperfusion injury index(including serum levels of cTnI and CK-MB)before and at 6,12,and 24 hours after operation,LVEF and LVEDD before and after 6 months of operation,NT-proBNP before and at 7 days,1 month,and 3 months after operation were compared and the incidence of major adverse cardiovascular events(MACE)within 12 months after operation were recorded.Results (1)There was no significant difference between the two groups in the number of stent implantation,the number of vascular lesions,or the incidence of coronary spasm(P>0.05);TIMI blood flow grading in nicorandil group was better than that in control group,and incidence of NRP in nicorandil group was lower than that in control group(P<0.05).(2)Time and method had interaction at serum levels of cTnI and CK-MB(P<0.05);time had significant main effect at serum levels of cTnI and CK-MB(P<0.05);method had significant main effect at serum levels of cTnI and CK-MB(P<0.05).Serum levels of cTnI and CK-MB in nicorandil group were lower than those in control group at 6,12 and 24 h after operation(P<0.05).(3)There was no significant difference in LVEF and LVEDD between the two groups before operation(P>0.05);6 months after operation,LVEF in nicorandil group was higher

关 键 词：心肌梗死 经皮腔内冠状动脉成形术 尼可地尔 无复流现象 心肌再灌注损伤 心功能 

分 类 号：R542.22[医药卫生—心血管疾病]