尼可地尔联合缺血后适应对STEMI患者急诊PPCI心肌血流灌注及预后的影响  

Effect of nicorandil combined with myocardial ischemic postconditioning on myocardial perfusion and prognosis in patients with STEMI undergoing PPCI

作　　者：卜云涛 丁超[1] 刘文秀 王刚[1] 程锦浩 BU Yuntao;DING Chao;LIU Wenxiu;WANG Gang;CHENG Jinhao(Department of Cardiovascular Medicine,the 980th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China,Shijiazhuang 050000,Hebei,China)

机构地区：[1]中国人民解放军联勤保障部队第980医院心血管内科,河北石家庄050000

出　　处：《中南医学科学杂志》2024年第4期628-631,共4页Medical Science Journal of Central South China

摘　　要：目的观察尼可地尔联合缺血后适应(MIP)对急性ST段抬高心肌梗死(STEMI)患者急诊直接经皮冠脉介入术(PPCI)心肌血流灌注及预后的影响。方法选取急诊行PPCI的STEMI患者200例,随机均分为对照组(PPCI)、尼可地尔组(PPCI+尼可地尔)、MIP组(PPCI+MIP)、联合组(PPCI+尼可地尔+MIP)。比较4组患者心肌血流灌注恢复、心肌损伤、心功能和预后的差异。结果与对照组比较,尼可地尔组、MIP组及联合组术后即刻TIMI血流帧数、术后24 h肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)、术后72 h cTnI降低,尼可地尔组及联合组术后无复流发生率降低,联合组术后12个月N末端B型脑钠肽前体、术后7天心律失常严重程度评分、12个月内心衰和心绞痛再住院率降低,尼可地尔组及联合组术后2 h ST段回落率升高(P<0.05)。联合组术后24 h CK-MB显著低于尼可地尔组(P<0.05)。结论尼可地尔联合MIP在心肌血流灌注恢复、降低心肌损伤及改善患者预后方面的效果值得肯定。Aim To observe the effect of nicordil combined with myocardial ischemic postconditioning(MIP)on myocardial perfusion and prognosis in patients with acute ST segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).Methods A total of 200 STEMI patients receiving PPCI in the emergency department were randomly divided into control group(PPCI),nicodil group(PPCI+nicodil),MIP group(PPCI+MIP),and combination group(PPCI+nicodil+MIP).The differences of myocardial blood perfusion recovery,myocardial injury,cardiac function and prognosis in 4 groups were observed and compared.Results Compared with the control group,immediate postoperative TIMI blood flow frame rate,cardiac troponin I(cTnI)and creatine kinase isoenzyme(CK-MB)at 24 h post-operation,and cTnI at 72 h after operation were decreased in nicorandil group,MIP group and joint group.The incidence of postoperative no reflow in the nicorandil group and combination group were decreased.The combination group showed a decrease in CK-MB at 72 h post-surgery,N-terminal B-type brain natriuretic peptide precursor at 12 months post-surgery,arrhythmia severity score at 7 days post-surgery,and readmission rate due to heart failure.The ST segment regression rate increased 2 hours after surgery in the nicorandil group and combination group(P<0.05).The postoperative CK-MB of the combination group was significantly lower than that of the nicorandil group at 24 h(P<0.05).Conclusion The effect of nicodil combined with MIP on myocardial perfusion recovery,myocardial injury reduction and the improvement of prognosis of patients is worthy of recognition.

关 键 词：STEMI 尼可地尔 心肌缺血后适应 经皮冠脉介入术 

分 类 号：R542.22[医药卫生—心血管疾病]