尼可地尔联合依那普利叶酸片对STEMI急诊PCI术后患者的效果观察  

Effect of nicorandil combined with enalapril folic acid tablets on patients after STEMI emergency PCI

作　　者：牟丽娜[1] 张俊岭[1] 王丽[1] 刘艳洁 吕文浩 MU Lina;ZHANG Junling;WANG Li(Harrison International Peace Hospital,Hebei,Hengshui 053000,China)

机构地区：[1]哈励逊国际和平医院,河北省衡水市053000 [2]河北省衡水市第四人民医院

出　　处：《河北医药》2020年第18期2740-2745,共6页Hebei Medical Journal

基　　金：衡水市科学技术研究与发展计划项目(编号:2017014013C-02)。

摘　　要：目的观察尼可地尔联合依那普利叶酸片对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入(PCI)术后的心肌损伤、心室重构、同型半胱氨酸(Hcy)及预后的影响。方法收集在我院胸痛中心的急性ST段抬高型心肌梗死患者300例。随机分为A、B、C组,每组100例。A组口服依那普利片10 mg,1次/d,B组口服依那普利叶酸片10.8 mg,1次/d,C组(联合用药组)口服尼可地尔5 mg,3次/d+依那普利叶酸片10.8 mg,1次/d。3组均行急诊PCI治疗及心梗相关治疗,均观察12周。检测PCI术前及PCI术后1、3、7、10 d血清肌钙蛋白(cTnI)水平,对比PCI术前及PCI术后1、3、7、10 d心电图变化。测定治疗前后N末端前体脑钠肽(Nt-proBNP)水平,对比治疗前后超声心动图指标[左心室舒张末期内径(LVEDd)、左心室射血分数(LVEF)、室间隔厚度(IVS)、左心室后壁厚度(LVPW)、右心室舒张末期窖指数(LVED-VI)]变化,测定治疗前、治疗后4、8、12周同型半胱氨酸(Hcy)水平;记录12周内病死率,再次住院率,主要心脏不良事件,药物的不良反应。结果B、C组PCI术后3、7、10 d cTnI低于A组(P<0.05),C组PCI术后10天cTnI水平低于B组(P<0.05);C组PCI术后7、10 d心电图相关导联抬高ST段回落>50%峰值发生率高于A、B组(P<0.05);3组经治疗后,出现显著下降的是LVED-VI、Nt-proBNP、LVEDd(P<0.05),显著上升的是LVEF(P<0.05);C组经治疗后,与A、B组比较,显著下降的是Nt-proBNP、LVEDd、LVED-VI(P<0.05),显著上升的是LVEF(P<0.05),B组经过治疗,A组比较,Nt-proBNP、LVED-VI出现显著下降(P<0.05)。而Hcy值,B、C组治疗后的第4、8、12周后,显著较低于A组,C组经过治疗8、12周后,较B组也显著比较低(P<0.05)。C组再住院率明显低于A、B组(P<0.05),而B、C组恶性心律失常和心力衰竭的发生几率显著低于A组,再发心绞痛发生率方面C组也大幅度低于A、B组(P<0.05)。结论尼可地尔联合依那普利叶酸片能够减轻心肌损伤,改�Objective To observe the effects of nicorandil combined with enalapril folic acid tablets on myocardial injury,ventricular remodeling,and homocysteine(Hcy)after emergency percutaneous coronary intervention(PCI)in patients with acute ST-elevation myocardial infarction(STEMI)and the prognosis of patients.Methods A total of 300 patients with acute STEMI who were treated in our hospital were enrolled in the study,who were randomly divided into groups A,group B,and group C,with 100 cases in each group.The patients in group A were treated by oral enalapril tablets 10mg once daily,and the patients in group B were treated by oral enalapril folic acid tablets 10.8mg once daily,and the patients in group C(combination treatment group)were treated by oral nicorandil 3 times daily and enalapril folic acid tablets 10.8mg once daily.The patients in the three groups underwent emergency PCI treatment and myocardial infarction-related treatment,and all the patients were observed for 12 weeks.Serum troponin(cTnI)levels were measured before PCI and at 1,3,7,and 10 days after PCI,and the ECG changes were compared before and at 1,3,7,and 10 days after PCI.The levels of N-terminal precursor brain natriuretic peptide(Nt-proBNP)before and after treatment were detected,and changes in echocardiographic indexes[left ventricular end diastolic diameter(LVEDd),left ventricular ejection fraction(LVEF),interventricular septal thickness(IVS),left ventricular posterior wall thickness(LVPW),right ventricular end diastolic volume index(LVED-VI)]were compared before and after treatment.Hcy levels before treatment,and at 4,8,12 weeks after treatment were measured,and death rate within 12 weeks,readmission rate,major adverse cardiac events,and adverse drug reactions were recorded.Results The cTnI levels in group B and C were significantly lower than those in group A at 3d,7d,and 10d after PCI(P<0.05),and the cTnI levels in group C were significantly lower than those in group B at 10d after PCI(P<0.05).In group C at 7 and 10 days after PCI,the incidence

关 键 词：尼可地尔 依那普利叶酸片 急性ST段抬高型心肌梗死 心肌损伤 左心室重构 同型半胱氨酸 

分 类 号：R542.22[医药卫生—心血管疾病]