静脉注射尼可地尔对急诊经皮冠状动脉介入治疗术后无复流和慢血流的影响

摘要

目的 探讨静脉注射尼可地尔对急诊经皮冠状动脉介入治疗(PCI)术后无复流和慢血流的影响.方法 将112例接受急诊PCI治疗的急性ST段抬高型心肌梗死患者随机分为尼可地尔组56例和对照组56例.尼可地尔组患者在支架植入前静脉推注尼可地尔6 mg,之后以6 mg/h静脉滴注1 h;对照组患者在支架植入前给予生理盐水20 ml静脉推注,继之将100ml生理盐水以100 ml/h静脉滴注1 h.观察两组术后心肌梗死溶栓试验(TIMI)血流分级、TIMI心肌灌注(TMP)分级、校正的TIMI帧数(CTFC)及术后30 d主要不良心血管事件(MACE)的发生情况.结果 两组患者性别、年龄、冠心病危险因素(吸烟史、高脂血症病史、高血压病史等)等基线资料、冠状动脉造影及PCI术相关指标比较,差异均无统计学意义(P>0.05).尼可地尔组术后TIMI血流分级<3级和TMP分级<3级的患者比例和CTFC均明显低于对照组(P<0.05).两组患者肌酸激酶(CK)峰值、CK-MB峰值、术后5~7 d左室射血分数、术后30 d死亡率及总MACE发生率比较,差异均无统计学意义(P>0.05).结论 静脉注射尼可地尔明显降低急诊PCI术后无复流和慢血流的发生率.%Objective To explore the effect of intravenous administration of nicorandil on no reflow and slow flow after emergency primary percutaneous coronary intervention(PCI).Methods A total of 112 patients with acute ST segment elevation myocardial infarction undergoing emergency PCI were randomly divided into nicorandil group(56 cases)and control group(56 cases).Patients in the nicorandil group were given intravenous injection of 6 mg nicorandil followed by intravenous drip of nicorandil at 6 mg/h for 1 h before stent implantation.Patients in the control group were given intravenous injection of 20 ml saline followed by intravenous drip of 100 ml saline at 100 ml/h for 1 h.Thrombolysis in myocardial infarction (TIMI)flow classification,TIMI myocardial perfusion(TMP)classification,corrected TIMI frame count (CTFC)and major adverse cardiovascular events(MACE)30 d after PCI between two groups were compared. Results Baseline data of gender,age,risk factors of coronary heart diseases such as history of smoking, hyperlipemia and hypertentsion and so on and related indexes of coronary angiography and PCI between the two groups were not significantly different(P>0.05).Ratios of patients with TIMI classification<3,TMP classification<3 and CTFC in nicorandil group were significantly lower than those in control group(P<0.05). Peak value of creatine kinase(CK)and CK-MB,left ventricular ejection fraction(LVEF)of 5 to 7 d after PCI,rate of mortality and rate of total MACE 30 d after PCI were not significantly different between two groups (P>0.05).Conclusion Intravenous administration of nicorandil can reduce the occurrence rate of no reflow and slow flow after emergency PCI.