尼可地尔治疗冠状动脉慢血流临床疗效观察

Clinical observation on the curative effect of Nicorandil in patients with coronary slow flow phenomenon

目的 观察尼可地尔联合阿托伐他汀治疗冠状动脉慢血流的临床疗效.方法 选择北京潞河医院2012年1月至2015年11月心内科住院行冠状动脉造影诊断为冠状动脉慢血流（CSFP）患者130例,平均年龄（55.73±8.52）岁,随机分为治疗组（65例）和对照组（65例）.两组均进行危险因素控制,并给予阿司匹林100 mg/d、阿托伐他汀20 mg/d,治疗组加用尼可地尔,每次5 mg,3次/d.每月随访1次,随访3个月,观察治疗前后每周心绞痛发作次数、血常规、生化、血脂、hs-CRP、心功能指标的变化.结果 与治疗前比较,两组治疗后血压、白细胞、空腹血糖、甘油三酯、尿酸、LDL、hs-CRP均明显下降（P＜0.05）.治疗后治疗组和对照组E/A比值与治疗前相比均明显升高（1.09±0.18比0.99±0.28;1.03±0.16比0.95±0.21,P＜0.05）,并且治疗组治疗后E/A比值明显高于对照组（1.09±0.18比1.03±0.16,P＜0.05）.治疗组心绞痛症状改善总有效率明显高于对照组（89.3％比73.8％,P＜0.05）,其中显效率治疗组明显高于对照组（70.8％比43.0％,P＜0.05）.结论 在控制危险因素和使用阿司匹林、阿托伐他汀治疗的基础上联合尼可地尔,可更加显著地改善CSFP症状和心脏舒张功能.

Objective To observe the curative effect of Nicorandil in patients with coronary slow flow phenomenon. Methods 130 cases with coronary slow flow phenomenon were randomly divided into treatment group（65 cases）, and control group（65 cases）. Both groups were given Aspirin 100 mg/d and Atorvastatin 20 mg/d, and control risk factors. Patients in treatment group were given Nicorandil additionally, 5 mg rid, for 3 months. Results The level of blood pressure, white blood cells, fasting blood glucose, triglyeerides, uric acid, LDL, hs- CRP in both groups was significantly lower after therapy. The E/A ratio of both groups was significantly higher after therapy （1.09±0.18 vs 0.99±0.28,1.03±0.16 vs 0.95±0.21,P〈0.05）. After treatment, the E/A ratio of treatment group was significantly higher than that of control group （1.09±0.18 vs 1.03±0.16, P〈0.05）. The total efficiency on improving angina pectoris in treatment group was significantly higher than that of control group（ 89.3% vs 73.8%, P〈0.05）. The significant efficiency on improving angina pectofis in treatment group was significantly higher than that of control group（70.8% vs 43.0%, P〈0.05）. Conclusion On the basis of controlling risk factors, Aspirin and Atorvastatin therapy, Nicorandil can more significantly improve angina pectoris and cardiac diastolic function in patients with coronary slow flow phenomenon.