尼可地尔对接受溶栓治疗再通的急性ST段抬高型心肌梗死患者的心肌保护效应

Myocardial protective effects of nicorandil on acute ST segment elevation myocardial infarction patients receiving successful thrombolysis

目的评价静脉溶栓联合尼可地尔的治疗方案是否能够提高急性ST段抬高型心肌梗死(STEMI)患者的治疗效果。方法入选就诊于保定市第一中心医院行溶栓治疗的急性STEMI患者,随机分为尼可地尔组和对照组,尼可地尔组在确诊后即刻口服尼可地尔20mg,之后5mg每日3次口服,对照组常规进行溶栓治疗,观察两组住院期间的心肌损伤程度,ST段回落,急性期心律失常的发生率,心功能状况,以及随访6个月的心功能状况及随访期内不良心血管事件的发生率。结果共入选121例患者,尼可地尔组64例,对照组57例,两组基线资料无明显差异。溶栓后4、12、24小时监测的肌钙蛋白I(cTNI)水平显示,两组在组间、不同时点以及组间和不同时点的交互作用差异均有统计学意义(P<0.05或<0.01),尼可地尔组cTNI水平明显低于对照组;溶栓后监测的患者心电图ST段回落情况显示,两组在组间、不同时点以及组间和不同时点的交互作用差异均有统计学意义(P<0.05或<0.01),尼可地尔组ST段回落明显大于对照组;急性期Curtis-Walker评分≥3分的比例尼可地尔组明显低于对照组(P<0.05);室壁运动积分指数尼可地尔组明显低于对照组(P<0.05);两组患者的不良心血管事件差异无统计学意义(P>0.05)。结论静脉溶栓联合口服尼可地尔治疗可进一步提高急性STEMI患者的心肌灌注水平,减少心肌损伤,改善心脏功能,减少心律失常的发生。

ABSTRACT：Objective To evaluate the myocardial protective effects of nicorandil on patients with ST segment elevation myocardial infarction（STEMI）receiving successful thrombolysis.Methods The STEMI patients receiving thrombolysis at the hospital were randomly divided into nicorandil group and control group.Patients in the nicorandil group received a loading dose of nicorandil 20 mg immediately after the diagnosis and a maintenance dose of nicorandil 5 mg three times a day.Patients in the control group received routine treatment.Then,the degree of myocardial injury,the ST-segment resolution,the incidence of cardiac arrhythmia and the heart function of the two groups were compared.Additionally,the major adverse cardiovascular events（MACE）and the heart function of two groups at six months after their discharge from the hospital were also observed.Results A total of 121 patients were enrolled in the study,including 64 cases in nicorandil group and 57 cases in control group.The general characteristics of the patients between two groups had no significant difference.After thrombolysis,the troponin I （cTNI）showed significant difference（P 〈0.05 or P 〈0.01）.The cTNI level was markedly lower after thrombolysis in nicorandil group than in control group.The ST-segment resolution also showed significant difference between two groups（P 〈0.05 or P 〈0.01）.The ST-segment resolution in nicorandil group was better after thrombolysis than that in control group.There were fewer patients with Curtis-Walker score no less than 3 in nicorandil group,which were prominently less than those in control group （P 〈0.05）.The Wall Motion Score Index（WMSI）in nicorandil group was also remarkably less than that in control group （P 〈0.05）.However,there was no significant difference in MACE events between two groups. Conclusion Thrombolysis combined with oral administration of nicorandil can increase the effects of myocardial reperfusion and reduce the myocardial injury,so as to improve the heart function and reduce cardiac arrhythmia of STEMI patients.