尼可地尔联合曲美他嗪治疗老年缺血性心肌病的疗效观察

摘要

Objective To observe the effect of nicorandil combined with trimetazidine on elderly patients with ischemic cardiomyopathy ( ICM). Methods Seventy-eight elderly patients with ICM were randomly divided into control group and observation group,with 39 cases in each group. Both groups received conventional treatment against coagulation,plaque growth and heart failure. Based on conventional therapy, the control group was given placebo while the observation group was given nicorandil and trimetazidine additionally. The treatment lasted for 6 months in both groups. The weekly frequency and duration of angina attack,plasma N-terminal pro-B-type natriuretic peptide(NT-proBNP) level,left ventricular end-systolic dimension(LVESD),left ventricular end-diastolic dimension(LVEDD),left ventricular ejection fraction (LVEF),6-minute walking test(6MWT) and rehospitalization rate within 6 months were observed in the two groups before and after treatment. Results After treatment,the weekly frequency and duration of angina attack in the two groups were all less than those before treatment, and the indexes above in the observation group were less than those in the control group(P<0. 05);the walking distance in 6MWT and the levels of LVESD,LVEDD,LVEF and NT-proBNP were improved significantly in both groups,and the indexes above in the observation group were superior to those in the control group(P<0. 05). The rehospitalization rate within 6 months after treatment in the observation group was lower than that in the control group(P<0. 05). Conclusion Nicorandil combined with trimetazidine,based on conventional treatment,can significantly alleviate angina symptoms,improve cardiac function and tolerance,and reduce rehospitalization rate in elderly patients with ICM.%目的 观察尼可地尔联合曲美他嗪治疗老年缺血性心肌病( ICM)的临床疗效.方法 将78例老年ICM患者随机分为对照组和观察组,每组39例,两组均给予常规抗血小板、稳定斑块、抗心力衰竭等治疗,在常规治疗的基础上,对照组给予安慰剂,观察组加用尼可地尔及曲美他嗪,疗程均为6个月.观察两组治疗前后每周心绞痛发作次数、持续时间及血浆N末端B型钠尿肽前体(NT-proBNP)水平、左心室收缩末内径( LVESD)、左心室舒张末内径( LVEDD)、左心室射血分数(LVEF)、6 min步行试验(6MWT)、6个月内再住院率.结果 治疗后,两组患者每周心绞痛发作次数、持续时间均少于治疗前,并且观察组少于对照组(P<0. 05);两组患者6 min步行距离、LVESD、LVEDD、LVEF、NT-proBNP水平均明显改善,并且观察组上述指标改善优于对照组(P<0. 05).观察组治疗6个月内再住院率低于对照组(P<0. 05).结论 在常规治疗的基础上联合尼可地尔及曲美他嗪治疗老年ICM可有效改善患者心绞痛症状,提高心功能及运动耐量,降低再住院率.