前列地尔联合尼可地尔对不稳定型心绞痛患者经皮冠状动脉介入术后的影响
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摘要
目的探讨前列地尔联合尼可地尔对不稳定型心绞痛(UAP)患者经皮冠状动脉介入术(PCI)后的影响。方法选取2018年1—9月大连市第三人民医院收治行择期PCI的UAP患者105例,按照入院顺序进行编号并采用随机数字表法分为前列地尔组、尼可地尔组和联合用药组,每组35例。在常规治疗基础上,前列地尔组患者于PCI前48 h和PCI后给予前列地尔注射液,尼可地尔组患者于PCI前48 h和PCI后给予尼可地尔片,联合用药组患者于PCI前48 h和PCI后给予前列地尔注射液联合尼可地尔片;3组患者均连续治疗1周。比较3组患者用药前及PCI后24 h心肌肌钙蛋白I(c TnI)、肌红蛋白(Mb)、肌酸激酶同工酶(CK-MB)、超敏C反应蛋白(hs-CRP)水平,用药前及PCI后1周左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD),并观察3组患者治疗期间药物不良反应发生情况及PCI后4周内主要心血管不良事件(MACE)发生情况。结果 (1)3组患者用药前cTnI、Mb、CK-MB和hs-CRP水平比较,差异无统计学意义(P>0.05);联合用药组患者PCI后24 h cTnI、Mb、CK-MB和hs-CRP水平低于前列地尔组、尼可地尔组(P<0.05)。(2)3组患者用药前LVEF、LVEDD比较,差异无统计学意义(P>0.05);联合用药组患者PCI后1周LVEF高于前列地尔组、尼可地尔组,LVEDD短于前列地尔组、尼可地尔组(P<0.05)。(3)3组患者治疗期间药物不良反应发生率比较,差异无统计学意义(P>0.05)。(4)3组患者PCI后4周内MACE发生率比较,差异无统计学意义(P>0.05)。结论前列地尔联合尼可地尔可有效改善UAP患者PCI后心功能,减轻患者心肌损伤程度及炎性反应,且未增加药物不良反应及MACE发生风险。
Objective To investigate the impact of alprostadil combined with nicorandil on postoperative unstable angina pectoris(UAP)patients treated by percutaneous coronary intervention(PCI).Methods A total of 105 UAP patients underwent selective PCI were selected in the Third People's Hospital of Dalian,and they were divided into alprostadil group,nicorandil group and combination group according to the admission sequence number and random number table method,with 35 cases in each group.Based on conventional treatment,patients in alprostadil group,nicorandil group and combination group received alprostadil injection,nicorandil tablets and alprostadil injection combined with nicorandil tablets 48 hours before PCI and after PCI,respectively;all of the three groups continuously treated for 1 week.cTnI,Mb,CK-MB and hs-CRP before medication and 24 hours after PCI,LVEF and LVEDD before medication and 1 week after PCI,incidence of adverse drug reactions during treatment and incidence of MACE within 4 weeks after PCI were compared in the three groups.Results(1)No statistically significant difference of cTnI,Mb,CK-MB or hs-CRP was found in the three groups before medication(P>0.05),while cTnI,Mb,CK-MB and hs-CRP in combination group were statistically significantly lower than thosein alprostadil group and nicorandil group 24 hours after PCI(P<0.05).(2)No statistically significant difference of LVEF or LVEDD was found in the three groups before medication(P>0.05);1 week after PCI,LVEF in combination group was statistically significantly higher than that in alprostadil group and nicorandil group,respectively,while LVEDD in combination group was statistically significantly shorter than that in alprostadil group and nicorandil group,respectively(P<0.05).(3)No statistically significant difference of incidence of adverse drug reactions was found in the three groups during treatment(P>0.05).(4)No statistically significant difference of incidence of MACE was found in the three group within 4 weeks after PCI(P>0.05).Conclusion Alprostadil combined with nicorandil can effectively improve the cardiac function in postoperative UAP patients treated by PCI,reduce the myocardial injury degree and inflammatory reaction,without increasing risk of adverse drug reactions and MACE.
Objective To investigate the impact of alprostadil combined with nicorandil on postoperative unstable angina pectoris(UAP)patients treated by percutaneous coronary intervention(PCI).Methods A total of 105 UAP patients underwent selective PCI were selected in the Third People's Hospital of Dalian,and they were divided into alprostadil group,nicorandil group and combination group according to the admission sequence number and random number table method,with 35 cases in each group.Based on conventional treatment,patients in alprostadil group,nicorandil group and combination group received alprostadil injection,nicorandil tablets and alprostadil injection combined with nicorandil tablets 48 hours before PCI and after PCI,respectively;all of the three groups continuously treated for 1 week.cTnI,Mb,CK-MB and hs-CRP before medication and 24 hours after PCI,LVEF and LVEDD before medication and 1 week after PCI,incidence of adverse drug reactions during treatment and incidence of MACE within 4 weeks after PCI were compared in the three groups.Results(1)No statistically significant difference of cTnI,Mb,CK-MB or hs-CRP was found in the three groups before medication(P>0.05),while cTnI,Mb,CK-MB and hs-CRP in combination group were statistically significantly lower than thosein alprostadil group and nicorandil group 24 hours after PCI(P<0.05).(2)No statistically significant difference of LVEF or LVEDD was found in the three groups before medication(P>0.05);1 week after PCI,LVEF in combination group was statistically significantly higher than that in alprostadil group and nicorandil group,respectively,while LVEDD in combination group was statistically significantly shorter than that in alprostadil group and nicorandil group,respectively(P<0.05).(3)No statistically significant difference of incidence of adverse drug reactions was found in the three groups during treatment(P>0.05).(4)No statistically significant difference of incidence of MACE was found in the three group within 4 weeks after PCI(P>0.05).Conclusion Alprostadil combined with nicorandil can effectively improve the cardiac function in postoperative UAP patients treated by PCI,reduce the myocardial injury degree and inflammatory reaction,without increasing risk of adverse drug reactions and MACE.
引文
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[5]2012 Writing Committee Members,JNEID H,ANDERSON J L,et al.2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/Non-ST-elevation myocardial infarction(updating the 2007 guideline and replacing the 2011 focused update):a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines[J].Circulation,2012,126(7):875-910.DOI:10.1161/CIR.0b013e318256f1e0.
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[7]孙烈俊,李利元.冠心病患者PCI手术围术期心肌损伤发生的影响因素探析[J].中西医结合心血管病电子杂志,2018,6(2):56.DOI:10.3969/j.issn.2095-6681.2018.02.043.
[8]任进平.冠心病患者PCI围术期心肌损伤的影响因素[J].实用临床医药杂志,2017,21(11):5-7,11.DOI:10.7619/jcmp.201711002.
[9]皮淑芳,郑刚,刘迎午,等.尼可地尔对老年急性ST段抬高型心肌梗死患者介入术后心功能的影响[J].中华老年心脑血管病杂志,2018,20(9):923-926.DOI:10.3969/j.issn.1009-0126.2018.09.007.
[10]郭舜奇,王文亮,罗燕华,等.前列地尔对改善急性心肌梗死PCI术后无复流现象的疗效观察[J].实用医学杂志,2018,34(16):2761-2765.
[11]MIYOSHI T,EJIRI K,KOHNO K,et al.Effect of remote ischemia or nicorandil on myocardial injury following percutaneous coronary intervention in patients with stable coronary artery disease:A randomized controlled trial[J].Int J Cardiol,2017,236:36-42.DOI:10.1016/j.ijcard.2017.02.028.
[12]林崇强,刘涛,廖望,等.尼可地尔对不稳定型心绞痛PCI术后病人心肌损伤标志物和炎症因子水平的影响[J].中西医结合心脑血管病杂志,2018,16(5):570-573.
[13]杨燕茹.前列地尔和尼可地尔对行PCI术患者心肌损伤保护作用的探讨[D].青岛:青岛大学,2017.
[2]NAPODANO M,DARIOL G,AL MAMARY A H,et al.Thrombus burden and myocardial damage during primary percutaneous coronary intervention[J].Am J Cardiol,2014,113(9):1449-1456.DOI:10.1016/j.amjcard.2014.01.423.
[3]马永东.不稳定型心绞痛PCI术后经尼可地尔治疗后对患者炎症因子水平以及心肌损伤标志物的影响[J].中西医结合心血管病电子杂志,2019,7(8):83-84.DOI:10.16282/j.cnki.cn11-9336/r.2019.08.057.
[4]蒋端.尼可地尔对不稳定型心绞痛患者PCI术后的心肌保护作用[J].中西医结合心血管病电子杂志,2018,6(28):88.DOI:10.16282/j.cnki.cn11-9336/r.2018.28.067.
[5]2012 Writing Committee Members,JNEID H,ANDERSON J L,et al.2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/Non-ST-elevation myocardial infarction(updating the 2007 guideline and replacing the 2011 focused update):a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines[J].Circulation,2012,126(7):875-910.DOI:10.1161/CIR.0b013e318256f1e0.
[6]DUCROCQ G,STEG P G,VAN'T HOF A,et al.Utility of postprocedural anticoagulation after primary PCI for STEMI:insights from a pooled analysis of the HORIZONS-AMI and EUROMAX trials[J].Eur Heart J Acute Cardiovasc Care,2017,6(7):659-665.DOI:10.1177/2048872616650869.
[7]孙烈俊,李利元.冠心病患者PCI手术围术期心肌损伤发生的影响因素探析[J].中西医结合心血管病电子杂志,2018,6(2):56.DOI:10.3969/j.issn.2095-6681.2018.02.043.
[8]任进平.冠心病患者PCI围术期心肌损伤的影响因素[J].实用临床医药杂志,2017,21(11):5-7,11.DOI:10.7619/jcmp.201711002.
[9]皮淑芳,郑刚,刘迎午,等.尼可地尔对老年急性ST段抬高型心肌梗死患者介入术后心功能的影响[J].中华老年心脑血管病杂志,2018,20(9):923-926.DOI:10.3969/j.issn.1009-0126.2018.09.007.
[10]郭舜奇,王文亮,罗燕华,等.前列地尔对改善急性心肌梗死PCI术后无复流现象的疗效观察[J].实用医学杂志,2018,34(16):2761-2765.
[11]MIYOSHI T,EJIRI K,KOHNO K,et al.Effect of remote ischemia or nicorandil on myocardial injury following percutaneous coronary intervention in patients with stable coronary artery disease:A randomized controlled trial[J].Int J Cardiol,2017,236:36-42.DOI:10.1016/j.ijcard.2017.02.028.
[12]林崇强,刘涛,廖望,等.尼可地尔对不稳定型心绞痛PCI术后病人心肌损伤标志物和炎症因子水平的影响[J].中西医结合心脑血管病杂志,2018,16(5):570-573.
[13]杨燕茹.前列地尔和尼可地尔对行PCI术患者心肌损伤保护作用的探讨[D].青岛:青岛大学,2017.