尼可地尔对冠心病患者球结膜微循环及血流动力学的影响

Effects of Bulbar Conjunctival Microcirculation and Hemodynamic by Nicorandil in Patients with Coronary Heart Disease

目的探讨尼可地尔对冠心病患者球结膜微循环的影响及急性心肌梗塞患者微循环和血流动力学的变化关系。方法冠心病患者28例 ,其中心绞痛18例 ,急性心肌梗塞10例。尼可地尔20mg口服 ,观察服药前及服药后30min、1h、1.5h、2h、3h、4h球结膜微循环五项指标。10例急性心肌梗塞床边经静脉插入四腔Swan -Ganz导管 ,同步观察球结膜微循环及心率、血压、右心房压、肺毛细血管楔嵌压、心输出量、心脏指数、体循环总阻力、全肺阻力。结果服用尼可地尔后微循环明显改善 ,表现为微血管扩张 ,血流速度加快 ,血液流态改善 ,毛细血管开放增多 ,统计学处理差异显著 (P<0.05～0.01)。10例急性心肌梗塞服用尼可地尔后 ,肺楔嵌压下降 ,心输出量增加 ,微血管扩张。服药后30min即有变化 ,1～2h最明显。微循环改善和血流动力学指标好转趋于一致。结论尼可地尔不仅可以扩张大的传输动脉 ,对冠心病患者的微循环障碍也有明显改善作用。急性心肌梗塞服用尼可地尔后微循环的改善和血流动力学指标的变化有很好的相关性。

Objective To explore the effects of microcirculation by nicorandil in patients with coronary heart disease (CHD). The relation between bulbar conjunctival microcirculatory changes and hemodynamic after nicorandil in patients with CHD. Methods In 18 cases with angina pectoris whose ages were 47～62 years and 10 cases with acute myocardial infarction (AMI) whose ages were 48～80 years. The observation on diameter of arteriole and venue, blood flow state and the number of open capillary before and after oral nicorandil 20 mg 30 min, 1h, 1.5h, 2h, 3h, 4h in patients with CHD. Swan-Ganz catheter was inserted in ten AMI patients to record the hemodynamic parameters including heart rate, mean arterial blood pressure, right atrial pressure, pulmonary capillary wedge pressure, cardiac output, cardiac index, systemic and pulmonary vascular resistance. The bulbar conjunctival microcirculatory and hemodynamic response to nicorandil were assessed in the 10 patients with AMI. Results The results showed that the microvessls dilated, but the effects were more obvious in venule than in arteriole. The blood flow velocity accelerated. Blood flow state was improved. The opening of capillary was increased, the pulmonary capillary wedge pressure decreased, microvessls dilated and cardiac output increased. The changes were quite distinct with 1～2h after medication. Conclusions There was dilation of large conduction artery and improving of microcirculatory disorder after oral nicorandil in patients with CHD. There was correlation between improving of bulbar conjunctival microcirculation and the changes of hemodynamic parameters after oral nicorandil on patients with AMI.