尼可地尔对PCI术后冠脉无复流及心肌损伤的影响

Effect of Nicorandil on Coronary No-reflow and Myocardial Injury after PCI

目的:观察尼可地尔对经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)患者术后冠脉无复流及心肌损伤的影响。方法:选取2015年12月—2016年11月于我院行PCI术的急性冠脉综合征患者88例,根据术前用药方法不同分为对照组与观察组,各44例。对照组接受PCI术常规药物治疗,在此基础上,观察组在术前7 d加服尼可地尔(5 mg,tid,术前5 h追加剂量为10 mg)治疗。比较两组心肌损伤标志物、无复流发生率及预后情况。结果:术后3 d,观察组肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)及心肌肌钙蛋白I(cTnI)明显低于对照组,差异有统计学意义(P <0.05);观察组无复流现象发生率明显低于对照组,差异有统计学意义(χ~2=4.42,P=0.04);观察组术后6个月健康调查简表(SF-36)评分明显高于对照组,西雅图心绞痛发作频率量表(SAQ)评分明显低于对照组,差异有统计学意义(P <0.05)。结论:尼克地尔可明显降低急性冠脉综合征患者PCI术后心肌无复流现象发生率,对再灌注心肌损伤具有一定保护作用,且预后较好,值得临床推广。

Objective:To observe the effect of nicorandil on postoperative coronary no-reflow and myocardial injury in patients undergoing percutaneous coronary intervention(PCI).Methods:88 patients with acute coronary syndromes who underwent PCI in our hospital from December 2015 to November 2016 were selected and divided into a control group and an observation group according to different preoperative drug use methods,44 cases each.The patients in the control group received conventional drug treatment for PCI.On this basis,the patients in the observation group were treated with nicorandil(5 mg,tid,supplemental dose of 10 mg 5 h before surgery)7 days before operation.The markers of myocardial injury,the incidence of no-reflow and prognosis were compared between the two groups.Results:The levels of creatine kinase(CK),creatine kinase isoenzyme(CK-MB)and cardiac troponin I(cTnI)3 days after operation in the observation group were significantly lower than those in the control group,with statistically significant differences(P<0.05).The incidence of no-reflow phenomenon in the observation group was significantly lower than that in the control group,and the difference was statistically significant(χ2=4.42,P=0.04).The scores of the MOS item short from health survey(SF-36)6 months after operation in the observation group were higher than those in the control group,and the scores of Seattle angina questionnaire(SAQ)were significantly lower than those in the control group,with statistically significant differences(P<0.05).Conclusion:Nicorandil can significantly reduce the incidence of myocardial no-reflow after PCI in patients with acute coronary syndromes,and has a protective effect on reperfusion myocardial injury,which is good in prognosis and worthy of clinical promotion.