硝普钠联合维拉帕米对冠状动脉介入术中无复流的效果

摘要

Objective:To explore therapeutic effects of sodium nitroprusside (SNP) combined verapamil on no-reflow during percutaneous coronary intervention (PCI).Methods: A total of 106 patients, who suffered from no-reflow during PCI in our department from Jan 2011 to Dec 2013, were selected.According to random number table method, patients were divided into SNP group (n=55, received SNP based on routine treatment) and combined treatment group (n=51, received verapamil based on SNP group).Cardiac troponin I (cTnI) level before and 16h~18h after PCI, cardiac function indexes after 12-month follow-up, incidence of major adverse cardiovascular events (MACE) were measured and compared between two groups.Results: Compared with before PCI, there were significant rise in cTnI level in both groups on 16~18h after PCI, P=0.001 both;compared with SNP group, there were significant reductions in cTnI level [(1.31±0.44)μg/L vs.(0.11±0.02)μg/L] and percentage of cTnI>0.10μg/L (94.5% vs.54.9%) in combined treatment group, P=0.001 both.Compared with SNP group after 12 months, there was significant rise in left ventricular ejection fraction [(62.29±3.06)% vs.(65.65±3.94)%], and significant reductions in left ventricular end-diastolic dimension[(50.24±3.73)mm vs.(47.60±4.72)mm] and left ventricular end-systolic dimension [(33.29±2.11)mm vs.(31.00±4.33)mm] in combined treatment group, P<0.05 all.There were no significant adverse reactions during hospitalization and follow-up in both groups.Conclusion: When no-reflow occurs during PCI, intracoronary injection of SNP combined verapamil can improve cardiac function, and its safety is good, which is worth extending.%目的:探讨硝普钠联合维拉帕米对经皮冠状动脉介入治疗(PCI)术无复流的效果.方法:选择2011年1月至2013年12月于我科PCI术中出现无复流的患者106例.根据随机数字表法,患者被分为硝普钠组(55例,在常规治疗基础上加用硝普钠)和联合治疗组(51例,在硝普钠组基础上加用维拉帕米).测定比较PCI术前、术后16h~18h两组心肌肌钙蛋白I(cTnI)水平,以及随访12个月后两组心功能指标、主要不良心血管事件(MACE)情况.结果:与术前比较,PCI术后16~18 h两组的cTnI水平均显著升高(P均=0.001);与硝普钠组比较,联合治疗组cTnI水平[(1.31±0.44)μg/L比(0.11±0.02)μg/L]和cTnI>0.10μg/L比例(94.5%比54.9%)显著降低,P均=0.001.12个月后,与硝普钠组比较,联合治疗组左室射血分数[(62.29±3.06)%比(65.65±3.94)%]显著升高,左室收缩末内径[(33.29±2.11)mm比(31.00±4.33)mm],左室舒张末内径[(50.24±3.73)mm比(47.60±4.72)mm]显著降低,P均<0.05.两组在住院及随访期间均无明显不良反应.结论:冠脉内联合注射维拉帕米和硝普钠可改善经皮冠脉介入治疗中出现无复流者的心功能,且安全性好,值得推广.