尼可地尔对PCI术中慢/无复流的STEMI患者心肌保护及并发症预防作用研究

摘要

目的 研究尼可地尔对经皮冠状动脉介入术(PCI)中慢/无复流的急性ST段抬高型心肌梗死(STEMI)患者心肌保护及并发症预防作用.方法 研究对象选取陕西省第四人民医院心血管内科于2015年10月至2017年6月间收治的PCI中慢/无复流的STEMI患者108例,采用随机数字法将其分为对照组和观察组,每组各54例.对照组患者术后根据病情给予常规对症治疗,在此基础上,观察组患者口服尼可地尔治疗.比较两组患者手术后不同时间点的梗死相关导联抬高ST段回落≥50%比例、血清心肌损伤标志物、血浆脑钠肽(BNP)及心脏结构和功能指标水平,同时比较两组患者术后30 d内的不良心血管事件发生率.结果 观察组患者PCI术后即刻、72 h、30 d的梗死相关导联抬高ST段回落≥50%比例均明显高于对照组(P＜0.05);PCI后24 h,观察组的血清CK-MB和cTnI水平均明显低于对照组(P＜0.01);PCI术后30 d,观察组的血浆BNP水平和左室舒张末期内径、左室收缩末期内径值均明显低于对照组(P＜0.01),左室射血分数均明显高于对照组(P＜0.01); 观察组术后30 d内的恶性心律失常、严重心力衰竭、心肌梗死复发等发生率均明显低于对照组(P＜0.05).结论 尼可地尔能减轻PCI中慢/无复流的STEMI患者心肌损伤,促进左心结构及功能恢复,降低不良心血管事件发生风险,值得在临床推广.%To study the myocardial protective and preventive effects of nicorandil on in STEMI patients with intra-operative slow or no reflow during PCI. Methods STEMI patients with intra-operative slow or no reflow during PCI (n=108) were chosen from Department of Cardiovascular Medicine of the Fourth People’ s Hospital of Shaanxi Province from Oct. 2015 to June 2017, and then divided randomly into control group and observation group (each n=54). The control group was given routine symptomatic therapies and observation group was additionally given oral nicorandil. The percentage of patients with resolution≥50% of elevated ST segment related to infarction, serum myocardial injury markers, plasma brain natriuretic peptide (BNP) and indexes of heart structure and function were compared between 2 groups at different time points after PCI. The incidence of adverse cardiovascular events was compared between 2 groups within 30 d after PCI. Results The percentage of patients with resolution≥50% of elevated ST segment related to infarction was significantly higher in observation group than that in control group at time points of immediately, 72 h and 30 d after PCI (P<0.05). The levels of CK-MB and cTnI were significantly lower in observation group than those in control group 24 h after PCI (P<0.01). The level of BNP and values of LVEDD and LVESD were significantly lower (P<0.01), and value of LVEF was significantly higher (P<0.01) in observation group than those in control group 30 d after PCI. The incidences of malignant arrhythmia, severe heart failure and relapse of myocardial infarction were significantly lower in observation group than those in control group 30 d after PCI (P<0.05). Conclusion Nicorandil can relieve myocardial injury, improve recovery of left heart structure and function and reduce incidence risk of adverse cardiovascular events in STEMI patients with intra-operative slow or no reflow during PCI, which is worth to be popularized in clinical practice.