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.
引文
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