摘要
目的探讨预防性注射尼可地尔应用在急性ST段抬高型心肌梗死经皮冠状动脉介入治疗(PPCI)术前,对患者心肌血流灌注及预后的影响。方法前瞻性选取急性ST段抬高型心肌梗死患者210例,按数字随机表法随机分为三组。在球囊通过梗死相关动脉病变后,A组直接进行PPCI,B组在冠状动脉内注射硝酸甘油300μg,C组在冠状动脉内注射尼可地尔(用0. 9%氯化钠溶液稀释) 10 ml,B组和C组均于注射30 s后再行PPCI。观察项目:三组TIMI血流分级、IRA血栓评分、病变血管支数、梗死相关动脉血管部位、血栓抽吸率、支架置入平均数量;术后TIMI帧值(TIMIFC)、无复流或者慢血流、冠状动脉内使用替罗非班及低分子肝素情况;术后评定心功能:患者检查超声心动图,评估肌酸激酶同工酶(CK-MB)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、室壁运动积分指数(WMSI)、肌钙蛋白(cTnI)以及术前与术后收缩压差值。术后7 d及术后3个月不良心血管事件。结果三组术前血流TIMI分级、IRA血栓评分、病变血管平均支数、梗死相关动脉部位、血栓抽吸例数、置入支架平均数量等差异均无统计学意义(P>0. 05)。术后C组即刻cTFC低于A组和B组(P <0. 05),C组术后慢血流或无复流、2 h内ST段回落明显高于A组和B组(P <0. 05),C组CK-MB峰值、LVEDD、WMSI、cTnI均低于A组和B组,LVEF水平高于A组和B组,术前与术后收缩压差值3组差异无显著性;各组术后7 d,C组再灌注心率失常发生率最低,明显低于其余两组(P <0. 05)。而三组心绞痛、靶血管再次血运重建、原心力衰竭加重以及死亡等不良心血管事件发生情况差异均无显著性(P> 0. 05)。术后3个月各组间不良心血管事件发生率差异均无统计学意义(P> 0. 05)。结论尼可地尔预防性应用在急性ST段抬高型心肌梗死PPCI术前,可改善患者术后心肌血流灌注水平,保护心肌功能,减少再灌注心律失常
Objective To investigate the effect of prophylactic injection of nicorandil on myocardial perfusion and prognosis in patients with acute ST-segment elevation myocardial infarction before PPCI.Methods After the balloon through the infarction related artery lesions,Group A performed PPCI directly,group B were given injection of nitroglycerin 300μg in coronary artery,group C nicorandil(diluted with 0.9%sodium chloride solution)10 ml,both two groups performed PPCI after injection for 30 s.The following index were observed,including TIMI flow grade,the IRA thrombus score,lesion counts and infarction related artery blood vessels,thrombus suction rate,the average number of stent implantation;Postoperative TIMI frame value(TIMI-FC)and no reflow or slow blood flow,coronary artery used for class and had low molecular heparin;Patients with postoperative evaluation of cardiac function:echocardiography examination,assessment of creatine kinase isoenzyme(CK-MB),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),ventricular wall motion score index(WMSI),troponin(cTnI),and preoperative and postoperative systolic blood pressure difference;adverse cardiovascular events postoperative 7 d and 3 months.Results The preoperative blood TIMI grading,IRA thrombus score,lesion blood vessel,on average,count,infarction related artery,thrombosis,suction cases,such as placing stents average number had no statistical significant difference(P>0.05).Postoperative immediate cTFC in group C was lower than that of group A and group B(P<0.05),postoperative blood flow to slow or no reflow,2 h in ST segment dropped in group C were significantly higher than group A and group B(P<0.05),peak CK-MB,LVEDD,WMSI,cTnI in group C were lower than that of group A and group B,the level of LVEF was higher than groups A and B,preoperative and postoperative systolic blood pressure in the three groups had no significant difference;the lowest incidence of reperfusion arrhythmia postoperative 7 d in C group was obviously lower than
作者
陈雨
林振宇
谷阳
严山
张喜文
CHEN Yu;LIN Zhen-yu;GU Yang(Department of Cardiology,Huaian First People's Hospital,Huaian Jiangsu 223300,China)
出处
《临床和实验医学杂志》
2018年第23期2500-2504,共5页
Journal of Clinical and Experimental Medicine
关键词
心肌梗死
急性ST段抬高型
尼可地尔
心肌血流灌注
心功能
Myocardial infarction
Acute ST segment elevation type
Nicorandil
Myocardial perfusion
Cardiac function
