曲美他嗪对冠状动脉介入治疗患者的心脏保护作用

Evaluation of the myocardial protection of trimetazidine during percutaneous coronary intervention：a multi-center randomized and controlled clinical study

目的 评价曲美他嗪对经皮冠状动脉介入治疗（PCI）患者的心肌保护作用.方法 在国内5家医院入选拟进行介入治疗的稳定性或不稳定性心绞痛患者共101例,随机分为曲美他嗪组（54例）和对照组（47例）.曲美他嗪组在术前（5±2）d开始服用曲美他嗪20 mg,3次/d,手术当天至少提前30 min给予60 mg负荷最,术后继续服用4周.对照组给予常规药物治疗.观察术中心绞痛发作及心电图变化情况;检测术前、术后12 h及24 h磷酸肌酸激酶同工酶浓度;观察术前、术后4周的心脏功能变化.结果 曲美他嗪组介入治疗术中心绞痛发生率显著低于对照组,差异有统计学意义（0%比25.5%,P〈0.001）.术中球囊扩张时曲美他嗪组出现缺血性心电图改变的比例小于对照组（60.8%比78.3%,P〈0.05）.PCI术后4周曲美他嗪组左室射血分数值高于对照组[（66.6±7.1）%比（63.0±7.7）%,P=0.03].结论 PCI围手术期应用曲美他嗪可以减少术中心绞痛发作,减轻心肌损伤,进一步改善PCI术后的左心功能.

Objective To evaluate the myocardial protection effects of trimetazidine during percutaneous coronary intervention （PCI）. Methods 101 patients from 5 hospitals with stable or unstable angina pectoris were enrolled in this study. All the patients were randomized into two groups： a trimetazidine group （n = 54） and a control group （ n = 47）. The trimetazidine group received oral trimetazidine 20 mg three times a day for （5±2 ） days before coronary angiography and a loading dose of 60 mg 30 minutes before PCI. The daily routine dosage was continued for 4 weeks after the procedure. The control group received similar treatment except trimetazidine. For each patient, the angina pectoris attacks, CK-MB,electrocardiogram and echocardiogram were noted. Results Angina did not occur in trimetazidine group during the procedure but occurred in 12 patients（ 25.5% ） in the control group（ P 〈0.001 ）. The changes of ST-segment and T wave during balloon dilatation in PCI procedure were less in the trimetazidine group （60.8% vs 78.3% , P 〈 0.05）. Ejection fraction in the trimetazidine group was higher than that in the control group 4 weeks [ （ 66.6±7.1 ） % vs （ 63.0±7.7 ） % , P = 0.03 ] after PCI. Conclusion Trimetazidine could reduce the frequency of angina pectoris attacks and myocardial damage during PCL It also improves left ventricular function during follow-up after PCL