术前冠状动脉内注射尼可地尔对急性心肌梗死患者术后心肌血流灌注水平及心功能的影响  

Effect of intracoronary injection of nicorandil before percutaneous coronary intervention on myocardial perfusion and cardiac function in patients with acute myocardial infarction

作　　者：李玲[1] 刘香格[1] 李强 邢慧敏 马晓鹏[1] 武报佳 范海超 任宇 付静静 Li Ling;Liu Xiangge;Li Qiang;Xing Huimin;Ma Xiaopeng;Wu Baojia;Fan Haichao;Ren Yu;Fu Jingjing(Department of Cardiology,Jizhong Energy Fengfeng Group Co.,Ltd.General Hospital,Handan 056200,China)

机构地区：[1]河北省邯郸市冀中能源峰峰集团有限公司总医院心内科,056200

出　　处：《心脑血管病防治》2022年第1期24-28,共5页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

摘　　要：目的探讨经皮冠状动脉介入治疗(PCI)术前冠状动脉内注射尼可地尔对急性心肌梗死(AMI)患者术后心肌血流灌注水平及心功能的影响。方法选取2017年2月至2019年12月冀中能源峰峰集团有限公司总医院收治的100例行PCI术的AMI患者,使用随机数字表法分为两组,各50例,对照组在PCI术前应用硝酸甘油,观察组在术前应用尼可地尔。对比两组患者PCI术前及术后的心肌血流灌注、心功能指标变化及预后情况。结果与治疗前比两组治疗后的心肌梗死溶栓试验(TIMI)血流分级均明显升高(χ^(2)=65.214、69.643,P<0.05),并且观察组术后TIMI 3级者占比明显高于对照组(χ^(2)=6.254,P<0.05)。观察组的无复流现象(NRP)发生率明显低于对照组(χ^(2)=5.107,P<0.05),ST段回落率(STR)明显高于对照组(χ^(2)=5.980,P<0.05),术后即刻校正TIMI血流帧数(cTFC)水平明显低于对照组(t=4.406,P<0.05)。与术前比两组术后的左心室射血分数(LVEF)均明显升高,左心室舒张末内径(LVEDD)、室壁运动积分指数(WMSI)明显降低(t=12.325、3.658、8.605、2.348、6.325、5.697,P<0.05)。观察组术后的LVEF水平明显高于对照组,LVEDD水平明显低于对照组(t=3.913、2.986,P<0.05)。观察组术中低血压发生率明显低于对照组(χ^(2)=22.222,P<0.05);两组术后2h内再灌注心律失常、术后24 h心绞痛、恶性心律失常、心力衰竭再住院发生率及死亡率比较,差异均无统计学意义(χ^(2)=0.000、0.244、0.687、0.687、0.020,P>0.05)。结论AMI患者PCI术前冠状动脉内注射尼可地尔能够有效改善冠状动脉微循环,增加心肌血流灌注,减少无复流的发生,保护心功能,并且对患者血压无影响。Objective To investigate the effect of intracoronary injection of nicorandil before percutaneous coronary intervention(PCI)on postoperative myocardial blood flow and function in patients with acute myocardial infarction(AMI).Methods 100 AMI patients undergoing PCI from Jan 2017 to Nov 2019 in Jizhong Energy Fengfeng Group Co.,Ltd.General Hospital were randomly divided into two groups,50 cases each.The control group was treated with sodium nitroprusside before PCI and the observation group with nicorandil before PCI.The changes of myocardial perfusion,cardiac function index before and after PCI,and prognosis were compared in the two groups.Results Compared with before treatment,the thrombolysis and thrombin inhibition in myocardial infarction(TIMI)blood flow grade after treatment in both groups were significantly higher(χ^(2)=65.214,69.643;P<0.05),and the proportion of the patients with TIMI grade 3 in the observation group was significantly higher than that in the control group(χ^(2)=6.254,P<0.05).The incidence of no-reflow phenomenon(NRP)in the observation group was significantly lower than that in the control group(χ^(2)=5.107,P<0.05),the ST segment drop rate(STR)was significantly higher than that in the control group(χ^(2)=5.980,P<0.05),and the level of correcting TIMI myocardial perfusion(cTFC)immediately after operation was significantly lower than that in the control group(t=4.406,P<0.05).Compared with before operation,the left ventricular ejection fraction(LVEF)was significantly increased,and the left ventricular end diastolic diameter(LVEDD)and wall motion integral index(WMSI)were significantly decreased in both groups(t=12.325,3.658,8.605,2.348,6.325,5.697;P<0.05).The level of LVEF in the observation group was significantly higher than that in the control group,the level of LVEDD was significantly lower than that in the control group(t=3.913,2.986;P<0.05).The incidence of intraoperative hypotension in the observation group was significantly lower than that in the control group(χ^(2)=22.222,P<0.05);t

关 键 词：急性心肌梗死 心肌血流灌注 经皮冠状动脉介入治疗 尼可地尔 心功能 

分 类 号：R542.22[医药卫生—心血管疾病]