尼可地尔对PCI术中慢/无复流的STEMI患者心肌保护及并发症预防作用研究
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摘要
目的研究尼可地尔对经皮冠状动脉介入术(PCI)中慢/无复流的急性ST段抬高型心肌梗死(STEMI)患者心肌保护及并发症预防作用。方法研究对象选取陕西省第四人民医院心血管内科于2015年10月至2017年6月间收治的PCI中慢/无复流的STEMI患者108例,采用随机数字法将其分为对照组和观察组,每组各54例。对照组患者术后根据病情给予常规对症治疗,在此基础上,观察组患者口服尼可地尔治疗。比较两组患者手术后不同时间点的梗死相关导联抬高ST段回落≥50%比例、血清心肌损伤标志物、血浆脑钠肽(BNP)及心脏结构和功能指标水平,同时比较两组患者术后30 d内的不良心血管事件发生率。结果观察组患者PCI术后即刻、72 h、30 d的梗死相关导联抬高ST段回落≥50%比例均明显高于对照组(P<0.05);PCI后24 h,观察组的血清CK-MB和cTnI水平均明显低于对照组(P<0.01);PCI术后30 d,观察组的血浆BNP水平和左室舒张末期内径、左室收缩末期内径值均明显低于对照组(P<0.01),左室射血分数均明显高于对照组(P<0.01);观察组术后30 d内的恶性心律失常、严重心力衰竭、心肌梗死复发等发生率均明显低于对照组(P<0.05)。结论尼可地尔能减轻PCI中慢/无复流的STEMI患者心肌损伤,促进左心结构及功能恢复,降低不良心血管事件发生风险,值得在临床推广。
Objective To study the myocardial protective and preventive effects of nicorandil on in STEMI patients with intra-operative slow or no reflow during PCI. Methods STEMI patients with intra-operative slow or no reflow during PCI(n=108) were chosen from Department of Cardiovascular Medicine of the Fourth People's Hospital of Shaanxi Province from Oct. 2015 to June 2017, and then divided randomly into control group and observation group(each n=54). The control group was given routine symptomatic therapies and observation group was additionally given oral nicorandil. The percentage of patients with resolution≥50% of elevated ST segment related to infarction, serum myocardial injury markers, plasma brain natriuretic peptide(BNP) and indexes of heart structure and function were compared between 2 groups at different time points after PCI. The incidence of adverse cardiovascular events was compared between 2 groups within 30 d after PCI. Results The percentage of patients with resolution≥50% of elevated ST segment related to infarction was significantly higher in observation group than that in control group at time points of immediately, 72 h and 30 d after PCI(P<0.05). The levels of CK-MB and cTnI were significantly lower in observation group than those in control group 24 h after PCI(P<0.01). The level of BNP and values of LVEDD and LVESD were significantly lower(P<0.01), and value of LVEF was significantly higher(P<0.01) in observation group than those in control group 30 d after PCI. The incidences of malignant arrhythmia, severe heart failure and relapse of myocardial infarction were significantly lower in observation group than those in control group 30 d after PCI(P<0.05). Conclusion Nicorandil can relieve myocardial injury, improve recovery of left heart structure and function and reduce incidence risk of adverse cardiovascular events in STEMI patients with intra-operative slow or no reflow during PCI, which is worth to be popularized in clinical practice.
Objective To study the myocardial protective and preventive effects of nicorandil on in STEMI patients with intra-operative slow or no reflow during PCI. Methods STEMI patients with intra-operative slow or no reflow during PCI(n=108) were chosen from Department of Cardiovascular Medicine of the Fourth People's Hospital of Shaanxi Province from Oct. 2015 to June 2017, and then divided randomly into control group and observation group(each n=54). The control group was given routine symptomatic therapies and observation group was additionally given oral nicorandil. The percentage of patients with resolution≥50% of elevated ST segment related to infarction, serum myocardial injury markers, plasma brain natriuretic peptide(BNP) and indexes of heart structure and function were compared between 2 groups at different time points after PCI. The incidence of adverse cardiovascular events was compared between 2 groups within 30 d after PCI. Results The percentage of patients with resolution≥50% of elevated ST segment related to infarction was significantly higher in observation group than that in control group at time points of immediately, 72 h and 30 d after PCI(P<0.05). The levels of CK-MB and cTnI were significantly lower in observation group than those in control group 24 h after PCI(P<0.01). The level of BNP and values of LVEDD and LVESD were significantly lower(P<0.01), and value of LVEF was significantly higher(P<0.01) in observation group than those in control group 30 d after PCI. The incidences of malignant arrhythmia, severe heart failure and relapse of myocardial infarction were significantly lower in observation group than those in control group 30 d after PCI(P<0.05). Conclusion Nicorandil can relieve myocardial injury, improve recovery of left heart structure and function and reduce incidence risk of adverse cardiovascular events in STEMI patients with intra-operative slow or no reflow during PCI, which is worth to be popularized in clinical practice.
引文
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[2]齐琪,陈涛,牛竞辉,等.冠状动脉靶血管内注射尼可地尔对急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗术中无复流现象的预防效果研究[J].中国全科医学,2017,20(23):2832-7.
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[7]黎文婷,姚朱华,庞志华,等.尼可地尔对急性非ST段抬高型心肌梗死PCI术中慢血流的疗效观察[J].天津医药,2017,45(11):1153-7.
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[9]胡强,刘华勇,梁东,等.尼可地尔联合替罗非班对急性冠脉综合征患者经皮冠状动脉介入术后无复流现象的预防作用[J].实用心脑肺血管病杂志,2017,25(2):903-4.
[10]张卫国.急性ST段抬高型心肌梗死患者血浆血红素加氧酶-1水平与急诊经皮冠状动脉介入术后无复流的关系[J].新乡医学院学报,2017,34(7):651-3.
[11]Duvall WL,Rai M,Ahlberg AW,et al.A multi-center assessment of the temporal trends in myocardial perfusion imaging[J].Journal of Nuclear Cardiology,2015,22(3):1-13.
[12]Puymirat E.Fractional Flow Reserve-Guided PCI for Stable Coronary Artery Disease-NEJM[J].New England Journal of Medicine,2014,371(13):1208-14.
[13]齐琪,牛竞辉,陈涛,等.尼可地尔联合替罗非班对急性ST段抬高型心肌梗死患者PPCI无复流的疗效观察[J].河北医科大学学报,2017,38(7):750-5.
[14]Jones WS,Clare RM,Chiswell K,et al.The impact of processes of care on myocardial infarct size in patients with ST-segment elevation myocardial infarction:observations from the CRISP-AMI trial[J].Clinical Cardiology,2015,38(1):25-31.
[15]马敏,祝烨,贺勇.尼可地尔通过调节血浆一氧化氮及内皮素1水平改善冠状动脉慢血流的临床研究[J].中国医药,2017,12(6):806-9.
[16]周立英,赖红梅,戴晓燕.急性ST段抬高心肌梗死行急诊经皮冠状动脉介入术无复流影响因素探讨[J].心肺血管病杂志,2014,33(2):206-8.
[2]齐琪,陈涛,牛竞辉,等.冠状动脉靶血管内注射尼可地尔对急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗术中无复流现象的预防效果研究[J].中国全科医学,2017,20(23):2832-7.
[3]Jones WS,Clare RM,Chiswell K,et al.The impact of processes of care on myocardial infarct size in patients with ST-segment elevation myocardial infarction:observations from the CRISP-AMI trial[J].Clinical Cardiology,2015,38(1):25-31.
[4]樊泽元,简新闻,季汉华.急诊PCI术中慢/无复流ST段抬高型急性心肌梗死患者术后口服尼可地尔观察[J].山东医药,2017,57(23):97-100.
[5]Chen Z,Chen X,Li S,et al.Nicorandil improves myocardial function by regulating plasma nitric oxide and endothelin-1 in coronary slow flow[J].Coronary Artery Disease,2015,26(2):114-21.
[6]付文波,丁世芳,陈志楠,等.急性STEMI患者急诊PCI术中无复流影响因素分析[J].中国循证心血管医学杂志,2014,16(3):288-90.
[7]黎文婷,姚朱华,庞志华,等.尼可地尔对急性非ST段抬高型心肌梗死PCI术中慢血流的疗效观察[J].天津医药,2017,45(11):1153-7.
[8]Ricottini E,Mangiacapra F,Nusca A,et al.Relation of Platelet Indices with Platelet Reactivity and Periprocedural Myocardial Infarction in Patients Undergoing Percutaneous Coronary Angioplasty[J].American Journal of Cardiology,2018,31(19):744-9.
[9]胡强,刘华勇,梁东,等.尼可地尔联合替罗非班对急性冠脉综合征患者经皮冠状动脉介入术后无复流现象的预防作用[J].实用心脑肺血管病杂志,2017,25(2):903-4.
[10]张卫国.急性ST段抬高型心肌梗死患者血浆血红素加氧酶-1水平与急诊经皮冠状动脉介入术后无复流的关系[J].新乡医学院学报,2017,34(7):651-3.
[11]Duvall WL,Rai M,Ahlberg AW,et al.A multi-center assessment of the temporal trends in myocardial perfusion imaging[J].Journal of Nuclear Cardiology,2015,22(3):1-13.
[12]Puymirat E.Fractional Flow Reserve-Guided PCI for Stable Coronary Artery Disease-NEJM[J].New England Journal of Medicine,2014,371(13):1208-14.
[13]齐琪,牛竞辉,陈涛,等.尼可地尔联合替罗非班对急性ST段抬高型心肌梗死患者PPCI无复流的疗效观察[J].河北医科大学学报,2017,38(7):750-5.
[14]Jones WS,Clare RM,Chiswell K,et al.The impact of processes of care on myocardial infarct size in patients with ST-segment elevation myocardial infarction:observations from the CRISP-AMI trial[J].Clinical Cardiology,2015,38(1):25-31.
[15]马敏,祝烨,贺勇.尼可地尔通过调节血浆一氧化氮及内皮素1水平改善冠状动脉慢血流的临床研究[J].中国医药,2017,12(6):806-9.
[16]周立英,赖红梅,戴晓燕.急性ST段抬高心肌梗死行急诊经皮冠状动脉介入术无复流影响因素探讨[J].心肺血管病杂志,2014,33(2):206-8.