尼可地尔对急性心肌梗死患者冠状动脉介入术后心功能及临床预后的影响

Effects of nicorandil on cardiac function and clinical outcomes in patients with acute myocardial infarction undergoing percutaneous coronary intervention

目的:研究尼可地尔对急性心肌梗死(AMI)患者冠状动脉介入(PCI)术后心功能及临床预后的影响。方法:入组66例AMI患者,随机分为对照组和尼可地尔组(各33例),尼可地尔组入院后立即给予尼可地尔4 mg静脉注射,以8mg/h速度持续静脉输注24 h,再通过测定8-异构前列腺素F_(2α)(8-epi-PGF_(2α))尿排泄率来评价两组患者体内活性氧类物质(ROS)的生成水平,并比较两组患者在心功能和临床心脏事件等方面的差异。结果:对照组患者8-epi-PGF2α尿排泄率在PCI术后升高了2倍,但尼可地尔组没有明显变化,两组间比较,差异有统计学意义(P<0.001)。尼可地尔组患者PCI术后即刻及第6个月的左室射血分数和心指数均高于对照组(P<0.05),尼可地尔组患者住院期间总的心脏事件发生率和再住院率也低于对照组(P<0.05)。结论 :尼可地尔能够改善AMI患者PCI术后的心功能及临床预后,而抑制ROS的生成是其可能的潜在机制。

Objective To explore the effects of nicorandil on cardiac function and clinical outcomes in patients with acute myocardial infarction （AMI） undergoing percutaneous coronary intervention （PCI）. Method Sixty-six patients with AMI were randomized into a control group and nicorandil group （n = 33 for each group）. In the nicorandil group, nicorandil （4 mg as a bolus injection followed by constant infusion at 8 rag/hour for 24 hours） was administered immediately after admission. Reactive oxygen species （ROS） formation was assessed by measuring urinary excretion of 8-epi-prostaglandin F2α （PGF2α） and compared between the two groups; cardiac function and cardiac events were also compared. Results Urinary 8-epi-PGF2α excretion was increased 2-fold at 60 to 90 minutes after PCI in the control group, whereas it was unchanged in the nicorandil group （P 〈 0.00l ）. Left ventricular ejection fraction and cardiac index immediately after PCI and at 6 months were greater in the nicorandil group than in the control group（P 〈 0.05）. Rates of total inhospital cardiac events and rehospitalization were lower in the nicorandil group than in the control group （P 〈 0.05）. Conclusions Nicorandil improves cardiac function and clinical outcomes in patients with AMI undergoing primary percutaneous coronary intervention. Suppression of ROS formation may be involved in the potential mechanism.