摘要
目的探讨尼可地尔联合血栓抽吸经皮冠状动脉介入治疗(PCI)对急性ST段抬高型心肌梗死(STEMI)再灌注心律失常(RA)的影响。方法选取潍坊医学院附属益都中心医院2019年1月至2020年6月收治的STEMI患者180例,采用随机数字表法分为尼可地尔联合血栓抽吸PCI组(NPCI组)90例和传统的直接PCI组(PPCI组)90例。比较两组患者介入治疗梗死相关动脉开通后心肌灌注情况[心肌灌注呈色(MBG)3级血流]及24 h内RA发生情况。结果 NPCI组MBG 3级血流发生率为84.44%(76/90),PPCI组为68.88%(62/90),两组差异有统计学意义(χ^(2)=6.01,P=0.01)。两组RA总发生率差异无统计学意义(χ^(2)=1.19,P=0.27),但NPCI组严重RA发生率为13.33%(12/90),低于PPCI组的27.77%(25/90),差异有统计学意义(χ^(2)=5.75,P=0.02)。以是否采用NPCI治疗为变量对严重RA的影响因素进行logistic回归分析,其OR值为0.40,95%CI 0.18~0.89,P=0.02。影响严重RA的其他因素为患者年龄(OR=0.71,95%CI 0.19~0.92,P=0.04)、发病至梗死相关动脉(IRA)再通时间(OR=0.62,95%CI 0.21~0.98,P=0.02)、梗死前心绞痛史(OR=0.67,95%CI 0.19~0.98,P=0.03)、入院血糖水平(OR=1.96,95%CI 1.05~5.78,P=0.03)、入院时白细胞计数(OR=1.99,95%CI 1.02~6.18,P=0.03)及心脏功能(OR=1.71,95%CI 1.06~6.91,P=0.04)。结论尼可地尔联合血栓抽吸PCI用于STEMI,在改善患者心肌血流灌注的同时,可减少RA的发生,优于传统的直接PCI,具有一定的临床意义和创新性。
Objective To investigate the effects of nicorandil combined with thrombus aspiration during percutaneous coronary intervention on reperfusion arrhythmia in patients with acute ST-elevation myocardial infarction.Methods 180 patients with acute ST-elevation myocardial infarction who received treatment in Yidu Central Hospital,Weifang Medical University,China between January 2019 and June 2020 were included in this study.They were randomly assigned to receive either nicorandil combined with thrombus aspiration during percutaneous coronary intervention(NPCI group,n=90)or conventional PCI(PPCI group,n=90).Myocardial perfusion(myocardial blush grade 3 blood flow)and the occurrence of reperfusion arrhythmia within 24 hours after treatment were compared between the NPCI and PPCI groups.Results The incidence of myocardial blush grade 3 blood flow in the NPCI group was significantly higher than that in the PPCI group[84.44%(76/90)vs.68.88%(62/90),χ^(2)=6.01,P=0.01].There was no significant difference in the total incidence of reperfusion arrhythmia between NPCI and PPCI groups(χ^(2)=1.19,P=0.27).The incidence of severe reperfusion arrhythmia in the NPCI group was significantly lower than that in the PPCI group[13.33%(12/90)vs.27.77%(25/90),χ^(2)=5.75,P=0.02].The influential factor of severe reperfusion arrhythmia was analyzed by logistic regression taking whether NPCI treatment was used as the variable(OR=0.40,95%CI 0.18-0.89,P=0.02).The other factors that affect severe reperfusion arrhythmia included age(OR=0.71,95%CI 0.19-0.92,P=0.04),time from onset to reperfusion of infarct related artery(OR=0.62,95%CI 0.21-0.98,P=0.02),dcuhistory of pre-infarct angina pectoris(OR=0.67,95%CI 0.19-0.98,P=0.03),admission blood glucose level(OR=1.96,95%CI 1.05-5.78,P=0.03),admission leukocyte count(OR=1.99,95%CI 1.02-6.18,P=0.03)and cardiac function(OR=1.71,95%CI 1.06-6.91,P=0.04).Conclusion Nicorandil combined with thrombus aspiration during percutaneous coronary intervention for the treatment of acute ST-elevation myocardial infarcti
作者
赵霞
刘中慧
王怀新
周树龙
Zhao Xia;Liu Zhonghui;Wang Huaixin;Zhou Shulong(Department of Emergency Medicine,Yidu Central Hospital,Weifang Medical University,Qingzhou 262500,Shandong Province,China)
出处
《中国基层医药》
CAS
2021年第9期1313-1317,共5页
Chinese Journal of Primary Medicine and Pharmacy
基金
山东省潍坊市科技发展计划项目(WFWSJK-2020-105)。
