应用心脏磁共振观察尼可地尔对行急诊冠状动脉介入的心肌梗死患者的影响  

Effects of nicorandil on patients with myocardial infarction underwent emergency PCI evaluated by cardiac magnetic resonance

作　　者：吴婷玉 黄楷森[2] 邓晓剑[2] 杨永强 WU Ting-yu;HUANG Kai-sen;DENG Xiao-jian;YANG Yong-qiang(Department of Intensive Care Medicine,Deyang People's Hospital,Deyang,Sichuan,618000,China)

机构地区：[1]德阳市人民医院重症医学科,四川德阳618000 [2]德阳市人民医院心血管内科,四川德阳618000

出　　处：《心血管康复医学杂志》2024年第2期165-169,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

基　　金：四川省科技计划项目应用基础研究基金(2018JY0389);2023年杏林学者-医院专项(XJ2023001001)。

摘　　要：目的:通过心脏核磁灌注扫描技术来定量评估直接冠状动脉介入手术(PCI)术后使用尼可地尔对ST段抬高型心肌梗死(STEMI)患者心肌梗死面积及微循环的改善效果。方法:选择2018年8月至2020年9月德阳市人民医院144例拟行直接PCI治疗的STEMI患者,随机分为对照组(69例,常规治疗)及尼可地尔组(75例),其中尼可地尔组是在进入导管室前给予口服5mg尼可地尔,并在术后持续口服尼可地尔片5mg/次,一天3次。术后(7±2)d行心脏核磁灌注成像评估心肌梗死面积、微循环阻塞质量、左心室射血分数(LVEF)以及心肌挽救指数等指标。结果:心肌磁共振结果显示与对照组相比,尼可地尔组心肌梗死面积[(29.27±13.96)%比(24.70±12.29)%]与微循环阻塞质量[(1.92±0.98)%比(1.48±0.81)%]显著降低,P<0.05或<0.01。尼可地尔组LVEF与心肌挽救指数较对照组上升,但无显著差异,P均>0.05。结论:直接PCI围术期早期应用尼可地尔可以显著缩小STEMI患者心肌梗死面积,改善微循环。Objective:The purpose of this study is to explore whether nicorandil can reduce myocardial infarction size and improve microcirculation of patients with ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PCI)quantitatively assessed by cardiac magnetic resonance perfusion imaging.Methods:A total of 144 STEMI patients who were proposed to primary PCI in Deyang People's Hospital from August 2018 to September 2020 were enrolled.Patients were randomly divided into control group(n=69,routine treatment)and nicorandil group(n=75).Patients in the nicorandil group were orally given nicorandil 5mg before entering catheter room,followed by 5mg,three times a day after PCI.On(7±2)d after PCI,cardiac magnetic resonance(CMR)perfusion imaging was performed to evaluate myocardial infarction size,microcirculatory obstruction mass,left ventricular ejection fraction(LVEF)and myocardial rescue index etc.Results:CMR results indicated that compared with the control group,there were significant reductions in myocardial infarction size[(29.27±13.96)%vs.(24.70±12.29)%]and microcirculatory obstruction mass[(1.92±0.98)%vs.(1.48±0.81)%]in the nicorandil group,P<0.05 or<0.01.There were no significant difference in LVEF and myocardial rescue index between two groups,which were higher in nicorandil group,P>0.05 both.Conclusion:Early usage of nicorandil during the perioperative period of primary PCI can significantly reduce myocardial infarction size and improve microcirculation in STEMI patients.

关 键 词：心肌梗死 血管成形术 气囊 冠状动脉 磁共振成像 尼可地尔 

分 类 号：R542.22[医药卫生—心血管疾病]