尼可地尔对冠状动脉旁路移植术患者术后心肌微循环及心肌损伤的影响  

Effect of nicorandil on myocardial microcirculation and myocardial injury of patients after coronary artery bypass grafting

作　　者：张松松[1] 陈金 潘渝[1] 刘曼莉[1] ZHANG Songsong;CHEN Jin;PAN Yu;LIU Manli(.Department of Critical Care Medicine,Guizhou Provincial People′s Hospital,Guiyang 550001,China)

机构地区：[1]贵州省人民医院重症医学科,贵阳市550001

出　　处：《临床合理用药杂志》2023年第24期16-19,共4页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的观察尼可地尔对冠状动脉旁路移植术(CABG)患者术后心肌微循环及心肌损伤的影响。方法按照随机数字表法将2018年12月—2022年12月贵州省人民医院行CABG治疗患者68例分为对照组和观察组,各34例。对照组患者给予常规治疗,观察组在对照组基础上予以尼可地尔治疗,2组均治疗1个月。比较2组TIMI血流分级,术前及术后1个月心肌微循环评价指标[左前降支(LAD)、左回旋支(LCX)、右冠脉(RCA)校正的TIMI血流帧数(cTFC)]、心功能指标[左心室射血分数(LVEF)、左心室收缩期末期内径(LVESD)、左心室舒张末期内径(LVEDD)]、心肌损伤标志物[N末端脑钠肽前体(NT-proBNP)、肌酸激酶同工酶(CK-MB)及心肌肌钙蛋白I(cTnI)]及不良反应。结果术后1个月,观察组TIMI血流分级优于对照组(u=2.338,P=0.019);2组LAD、LCX、RCA的cTFC均较术前减小,且观察组小于对照组(P<0.05或P<0.01);2组LVEF高于术前,LVESD、LVEDD小于术前,且观察组LVEF高于对照组,LVESD、LVEDD小于对照组(P<0.05或P<0.01);2组血浆NT-proBNP、CK-MB、cTnI水平低于术前,且观察组低于对照组(P<0.05或P<0.01)。观察组与对照组不良反应总发生率比较,差异无统计学意义(14.71%vs.8.82%,χ^(2)=0.142,P=0.707)。结论尼可地尔可有效调节CABG患者术后心肌微循环,改善心功能,增加血流灌注,减轻心肌损伤,且不良反应少。Objective To investigate the effect of nicorandil on myocardial microcirculation and myocardial injury of patients after CABG.Methods Sixty-eight patients who received CABG in Guizhou Provincial People′s Hospital from December 2018 to December 2022 were selected,and they were divided into the control group and the observation group according to random number table method,34 cases in each group,of which patients in the control group were given routine treatment,and patients in the observation group were given nicorandil on the basis of the control group,both groups were treated for 1 month.TIMI blood flow classification,myocardial microcirculation indexes(cTFC of LAD,LCX,RCA),cardiac function indexes(LVEF,LVESD,LVEDD),myocardial injury markers(NT-proBNP,CK-MB,cTnI)before and after 1 month of operation,and incidence of adverse reactions were compared between the two groups.Results TIMI blood flow classification after 1 month of operation in the observation group was better than that in the control group(u=2.338,P=0.019).After 1 month of operation,cTFC of LAD,LCX,RCA of the two groups were less than those before operation,and the indexes of the observation group were less than those in the control group(P<0.05 or P<0.01);LVEF of the two group was higher than that before operation,LVESD,LVEDD were smaller than those before operation,and LVEF in the observation group was higher than that in the control group,LVESD,LVEDD were smaller than those in the control group(P<0.05 or P<0.01);Plasma levels of NT-proBNP,CK-MB,cTnI of the two groups were lower than those before operation,and the indexes of the observation group were lower than those of the control group(P<0.05 or P<0.01).There was no significant difference of incidence of adverse reactions between the observation group and the control group(14.71%vs.8.82%,χ^(2)=0.142,P=0.707).Conclusion Nicorandil can more effectively regulate myocardial microcirculation of patients after CABG,improve cardiac function and increase blood perfusion,reduce myocardial injury,and wi

关 键 词：冠状动脉旁路移植术 尼可地尔 心肌微循环 N末端脑钠肽前体 心功能 

分 类 号：R654.2[医药卫生—外科学]