曲美他嗪对不稳定型心绞痛患者经皮冠状动脉介入治疗围术期的疗效  

Curative effect of trimetazidine during percutaneous coronary intervention in patients with unstable angina pectoris

作　　者：周维伟[1] 赵冰[1] 刘淑满[1] 杨春霞[1] 

机构地区：[1]北京市顺义区医院药剂科,北京100300

出　　处：《中国循证心血管医学杂志》2015年第5期666-668,671,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的评估曲美他嗪对不稳定型心绞痛患者经皮冠状动脉介入治疗(PCI)围术期的影响。方法选取2013年12月~2014年11月顺义区医院住院并行冠状动脉介入治疗的不稳定型心绞痛患者79例,其中男性52例,女性27例,平均年龄(59.3±9.4)岁。入选者随机分为常规治疗组(40例)和曲美他嗪组(39例)。常规治疗组给予阿司匹林、硫酸氢氯吡格雷、他汀类等药物治疗,曲美他嗪组在常规药物治疗的基础上于PCI术前3 d口服曲美他嗪20 mg,3/日,术后继续服用。所有患者均于PCI术前、术后24h检测肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)和心肌肌钙蛋白T(c Tn T)变化情况。比较两组临床疗效。采用TIMI帧数(TFC)评估冠状动脉血流改善情况。结果常规治疗组PCI术后较术前CK、CK-MB和c Tn T浓度升高,差异有统计学意义(P均<0.05)。与常规治疗组术后比较,曲美他嗪组CK、CK-MB和c TNT均降低,(102.52±30.40)U/L vs.(82.37±22.40)U/L、(19.52±3.49)U/L vs.(14.37±2.68)U/L、(0.13±0.12)ng/ml vs.(0.05±0.08)ng/ml,差异有统计学意义(P均<0.05)。常规治疗组临床显效16例(40.0%),有效14例(35.0%),总有效率为75.0%;曲美他嗪组临床显效26例(66.7%),有效9例(23.1%),总有效率为89.7%,两组临床总有效率比较差异有统计学意义(P<0.05)。曲美他嗪组前降支和回旋支的平均TFC值明显低于常规治疗组,差异具有统计学意义(P均<0.05)。结论曲美他嗪可以抑制PCI围术期相关心肌损伤,且对冠状动脉血流储备具有较好的改善作用。Objective To review the influence of trimetazidine during percutaneous coronary intervention(PCI) in patients with unstable angina pectoris(UAP). Methods UAP patients(n=79, male 52, female 27 and average age=59.3±9.4) were chosen from Dec. 2013 to Nov. 2014. The patients were randomly divided into routine group(n=40) and trimetazidine group(n=39). The routine group was treated with aspirin, clopidogrel and statins, and trimetazidine group additionally with trimetazidine orally(20 mg, 3 times a day) 3 d before PCI and continuously after PCI. The changes of creatine kinase(CK), creatine kinase MB(CK-MB) and cardiac troponin T(c Tn T) were detected in all patients before and 24 h after PCI. The curative effects were compared between 2 groups, and improvement of coronary artery flow was reviewed by using TIMI frame count(TFC). Results The levels of CK, CK-MB and c Tn T increased in routine group after PCI(all P<0.05). Compared with routine group after PCI, the levels of CK [(102.52±30.40) U/L vs.(82.37±22.40) U/L], CK-MB [(19.52±3.49) U/L vs.(14.37±2.68) U/L] and c Tn T [(0.13±0.12) ng/m L vs.(0.05±0.08) ng/m L] decreased in trimetazidine group(all P<0.05). There were 16 cases(40%) with obvious curative effect, 14(35%) with curative effect and the total effective rate was 75.0% in routine group. There were 26 cases(66.7%) with obvious curative effect, 9(23.1%) with curative effect and the total effective rate was 89.7% in trimetazidine group(P<0.05). The average TFC values of anterior descending branch and circumflex branch or coronary artery were significantly lower in trimetazidine group than those in routine group(all P<0.05). Conclusion Trimetazidine can inhibit perioperative myocardial injury correlated to PCI, and improve coronary flow reserve.

关 键 词：曲美他嗪 PCI 心肌保护 TIMI帧数 

分 类 号：R541.4[医药卫生—心血管疾病]