冠脉内注射尼可地尔对急诊PCI无复流及心功能影响的临床研究
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摘要
目的:研究冠脉内注射尼可地尔能否预防和解除急诊PCI术中无复流现象。方法:入选行急诊PCI的患者192例,随机分为尼可地尔预防组和非预防组,每组96例。预防组介入术前冠脉内注射5 ml 0.9%氯化钠注射液稀释后的尼可地尔2 mg,非预防组介入术前冠脉内注射5 ml 0.9%氯化钠注射液。观察两组术中无复流现象的发生率。预防组发生无复流的患者术中随机分为干预A组和非干预A组两组,分别冠脉内注射尼可地尔和0.9%氯化钠注射液。非预防组发生无复流的患者术中随机分为干预B组和非干预B组,分别冠脉内注射尼可地尔和0.9%氯化钠注射液。比较观察两亚组治疗无复流成功率。结果:预防组术中发生无复流6例,少于非预防组的14例,差异有统计学意义(P<0.05)。各亚组无复流的发生率比较差异无统计学意义(P>0.05)。与无复流的发生相关的因素有性别(男性)、血压病史、糖尿病病史、吸烟史、术前心功能Killip分级差(r=0.61、0.72、0.86、0.77、0.56,P<0.05)。结论:冠脉内注射尼可地尔可预防急诊PCI术中无复流的发生,但是不能解除无复流现象。
Objective:To study whether Nicorandil can prevent and relieve no-reflow in emergency PCI after injection of Nicorandil in coronary artery.Method:The PCI was made in 192 patients.All the selected patients were randomly divided into Nicorandil prevention group and no-Nicorandil prevention group,96 cases in each group.In the Nicorandil group,2 mg Nicorandil diluted by 5 ml 0.9% Sodium Chloride Injection was infused to coronary artery before PCI.In the no-Nicorandil prevention group,5 ml 0.9% Sodium Chloride Injection was infused to coronary artery before PCI.The incidence of no-reflow phenomenon in both groups was observed.Patients with no-reflow in the Nicorandil prevention group were randomly divided into Nicorandil intervention group and no-Nicorandil intervention group.Nicorandil and 0.9% Sodium Chloride Injection were injected into the coronary artery respectively.Patients with no-reflow in the no-Nicorandil prevention group were randomly divided into Nicorandil intervention group and no-Nicorandil intervention group too,Nicorandil and 0.9% Sodium Chloride Injection were injected into the coronary artery respectively.Observe the success rate of reversing no-reflow in two groups.Result:There were 6 cases of no-reflow in prevention group,less than 14 cases of no-nicorandil prevention group(P<0.05).There was no statistical difference in the incidence of no-reflow among the subgroups(P>0.05).The related factors of no-reflow were sex(male),history of blood pressure,history of diabetes mellitus,history of smoking,Killip grading difference of preoperative cardiac function(r=0.61,0.72,0.86,0.77,0.56,P<0.05).Conclusion:Injection of nicorandil in coronary artery can prevent noreflow in emergency PCI.But nicorandil can not reverse no-reflow.
Objective:To study whether Nicorandil can prevent and relieve no-reflow in emergency PCI after injection of Nicorandil in coronary artery.Method:The PCI was made in 192 patients.All the selected patients were randomly divided into Nicorandil prevention group and no-Nicorandil prevention group,96 cases in each group.In the Nicorandil group,2 mg Nicorandil diluted by 5 ml 0.9% Sodium Chloride Injection was infused to coronary artery before PCI.In the no-Nicorandil prevention group,5 ml 0.9% Sodium Chloride Injection was infused to coronary artery before PCI.The incidence of no-reflow phenomenon in both groups was observed.Patients with no-reflow in the Nicorandil prevention group were randomly divided into Nicorandil intervention group and no-Nicorandil intervention group.Nicorandil and 0.9% Sodium Chloride Injection were injected into the coronary artery respectively.Patients with no-reflow in the no-Nicorandil prevention group were randomly divided into Nicorandil intervention group and no-Nicorandil intervention group too,Nicorandil and 0.9% Sodium Chloride Injection were injected into the coronary artery respectively.Observe the success rate of reversing no-reflow in two groups.Result:There were 6 cases of no-reflow in prevention group,less than 14 cases of no-nicorandil prevention group(P<0.05).There was no statistical difference in the incidence of no-reflow among the subgroups(P>0.05).The related factors of no-reflow were sex(male),history of blood pressure,history of diabetes mellitus,history of smoking,Killip grading difference of preoperative cardiac function(r=0.61,0.72,0.86,0.77,0.56,P<0.05).Conclusion:Injection of nicorandil in coronary artery can prevent noreflow in emergency PCI.But nicorandil can not reverse no-reflow.
引文
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[8]陈清杰,杨毅宁,马依彤,等.尼可地尔对急性心肌梗死再灌注疗效的Meta分析[J].中国循证医学杂志,2012,12(11):1330-1338.
[9]Matsubara T,Minatoguchi S,Matsuo H,et al.Three minute,but not one minute,ischemia and nicorandil have a preconditioning effect in patients with coronary artery disease[J].J Am Coll Cardiol,2000,35(2):345-351.
[2]方唯一,韩文正.冠状动脉无复流的研究进展[J].内科急危重症杂志,2015,21(6):404-406.
[3]Kalogeris T,Baines C P,Krenz M,et al.Cellbiology of ischemiareperfusion injury[J].Int Rev Cell Mol Biol,2012,298:229-317.
[4]王佐岩,刘娜,雷力成,等.中性粒细胞计数与急诊PCI术中无复流现象的关系研究[J].临床和试验医学杂志,2013,12(4):249-255.
[5]洁芸,叶新和,杨承健.冠脉无复流现象的研究进展[J].中国微循环,2008,12(6):395-398.
[6]Kostic J,Djordjevic-Dikic A,Dobric M,et al.The effects of nicorandil on microvascular function in patients with ST segment elevation myocardial infarction undergoing primary PCI[J].Cardiovascular Ultrasound,2015,13(26):20.
[7]Imagawa J,Baxter G F,Yellon D M.Myocardial protection afforded by nicorandil and ischaemic preconditioning in a rabbit infarct model in vivo[J].J Cardiovasc Pharmacol,1998,31:74-79.
[8]陈清杰,杨毅宁,马依彤,等.尼可地尔对急性心肌梗死再灌注疗效的Meta分析[J].中国循证医学杂志,2012,12(11):1330-1338.
[9]Matsubara T,Minatoguchi S,Matsuo H,et al.Three minute,but not one minute,ischemia and nicorandil have a preconditioning effect in patients with coronary artery disease[J].J Am Coll Cardiol,2000,35(2):345-351.