尼可地尔改善急性前壁心肌梗死伴心力衰竭患者PCI术后血流动力学的研究

摘要

目的 观察尼可地尔对急性前壁心肌梗死伴心力衰竭患者PCI术后血流动力学及心功能的影响.方法 入选解放军总医院心内科监护室于2015年2月~2017年2月收治的急性前壁心肌梗死患者120例, 随机分为对照组(n=60)和观察组(n=60).对照组给予常规利尿、扩血管等治疗,观察组在常规治疗的基础上加用尼可地尔.利用TIMI分级和TMPG分级评价冠状动脉血流及心肌灌注情况,采用脉搏指示连续心排量(PICCO) 监测仪测量两组患者治疗前后心脏指数(CI)、全心舒张末容积指数(GEDI)、全身血管阻力指数(SVRI) 变化情况;应用彩色多普勒测量两组患者治疗前后左室射血分数(LVEF);同时监测两组患者脑钠肽(BNP)水平.结果 两组患者治疗前后比较,GEDI、CI、SVRI、LVEF、BNP值均改善;观察组各项指标均较对照组也明显改善,差异有统计学意义(P<0.05).观察组的总有效率明显高于对照组(93.33% vs. 65.00%,P<0.05).结论 尼可地尔可以改善急性前壁心肌梗死伴心力衰竭患者近期血流动力学及心功能.%Objective To observe the effects of nicorandil on hemodynamics and cardiac function after PCI in patients with acute anterior myocardial infarction and heart failure. Methods A total of 120 patients with acute anterior myocardial infarction treated in PLA General Hospital from February 2015 to February 2017 were recruited in this study, and then randomly divided into control group (n=60) and observation group (n=60). The control group was treated with conventional diuretic and vasodilator therapy, while the observation group was given nicorandil in addition. Using TIMI classification and TMPG grading to evaluate coronary blood flow and myocardial perfusion. Pulse-indicated continuous cardiac output (PICCO) monitoring system was used to measure cardiac index (CI), global end-diastolic volume index (GEDI), and systemic vascular resistance index (SVRI). Left ventricular ejection fraction (LVEF) was detected by color doppler ultrasound examination, and the changes of brain natriuretic peptide (BNP) and heart function improvement were recorded at the same time. Results LVEF, CI, GEDI, SVRI and BNP were significantly improved in the both groups after treatment. The indexes of the patients in nicorandil group were significantly improved compared with those in the control group, and the differences were statistically significant (P<0.05). The total effective rate of observation group was significantly higher than the control group (93.33% vs. 65.00%, P<0.05). Conclusion Nicorandil can improve the recent hemodynamic and cardiac function after PCI in patients with acute anterior wall myocardial infarction with heart failure.