硝苯地平对经桡动脉入路行冠状动脉造影术/经皮冠状动脉介入术的冠心病患者内皮依赖性血管舒张功能的影响

Impact of Nifedipine on Endothelium-dependent Flow-mediated Dilation in Coronary Heart Disease Patients Undergoing Transradial Approach Coronary Angiography or Percutaneous Coronary Intervention

目的探讨硝苯地平对经桡动脉入路行冠状动脉造影术/经皮冠状动脉介入术(PCI)的冠心病患者内皮依赖性血管舒张功能(FMD)的影响。方法选取2016年7月—2017年6月于秦皇岛市第一医院行冠状动脉造影术/PCI的冠心病患者120例,采用随机数字表法分为对照组与观察组,每组60例。两组患者均经桡动脉入路行冠状动脉造影术/PCI,观察组患者于术前5 min舌下含服硝苯地平片治疗。记录两组患者桡动脉痉挛发生情况,比较两组患者术前及术后1、2 d穿刺侧桡动脉直径及穿刺侧桡动脉和肱动脉FMD,术前及术后即刻内皮素、一氧化氮水平。结果两组患者桡动脉痉挛发生率比较,差异无统计学意义(P>0.05)。两组患者术前及术后1、2 d穿刺侧桡动脉直径比较,差异无统计学意义(P>0.05);两组患者术后2 d穿刺侧桡动脉直径大于术前(P<0.05)。术前两组患者穿刺侧桡动脉FMD比较,差异无统计学意义(P>0.05);术后1、2 d观察组患者穿刺侧桡动脉FMD优于对照组(P<0.05);两组患者术后1、2 d穿刺侧桡动脉FMD劣于术前(P<0.05)。术前及术后1、2 d两组患者穿刺侧肱动脉FMD比较,差异无统计学意义(P>0.05),术后2 d两组患者穿刺侧肱动脉FMD劣于术前(P<0.05)。术前两组患者内皮素、一氧化氮水平比较,差异无统计学意义(P>0.05);术后即刻观察组患者内皮素水平低于对照组(P<0.05),而术后即刻两组患者一氧化氮水平比较,差异无统计学意义(P>0.05);术后即刻两组患者内皮素水平高于术前(P<0.05)。结论硝苯地平可有效改善经桡动脉入路行冠状动脉造影术/PCI的冠心病患者桡动脉FMD,提高内皮素水平,但对肱动脉FMD无明显改善作用。

Objective To investigate the impact of nifedipine on endothelium-dependent flow-mediated dilation（FMD） in coronary heart disease patients undergoing transradial approach coronary angiography（CAG） or percutaneous coronary intervention（PCI）. Methods A total of 120 coronary heart disease patients undergoing transradial approach CAG or PCI were selected in the First Hospital of Qinhuangdao from July 2016 to June 2017, and they were divided into control group and observation group according to random number table, each of 60 cases. Patients in the two groups received transradial approach CAG or PCI, but patients in observation group received sublingual administration of nifedipine 5 minutes before transradial approach CAG or PCI. Incidence of radial artery spasm, punctured radial artery diameter, endothelium-dependent FMD of punctured radial artery and brachial artery before operation, 1 day and 2 days after operation, ET and NO before operation and immediately after operation were compared between the two groups. Results No statistically significant differences of incidence of radial artery spasm was found between the two groups（P〉0.05）. No statistically significant differences of punctured radial artery diameter was found between the two groups before operation, 1 day or 2 days after operation（P〉0.05）; 2 days after operation, punctured radial artery diameter in the two groups were statistically significantly larger than that before operation, respectively（P〈0.05）. No statistically significant differences of endothelium-dependent FMD of punctured radial artery was found between the two groups before operation（P〉0.05）, while endothelium-dependent FMD of punctured radial artery in observation group was statistically significantly better than that in control group 1 day and 2 days after operation, respectively（P〈0.05）; 1 day and 2 days after operation, endothelium-dependent FMD of punctured radial artery in the two groups was statistically significantly worse than that before operation, respectively（P〈0.05）. No statistically significant differences of endothelium-dependent FMD of punctured brachial artery was found between the two groups before operation, 1 day or 2 days after operation（P〉0.05）; 2 days after operation, endothelium-dependent FMD of punctured brachial artery in the two groups were statistically significantly worse than that before operation（P〈0.05）. No statistically significant differences of ET or NO was found between the two groups before operation, nor was NO immediately after operation（P〉0.05）, while ET in observation group was statistically significantly lower than that in control group immediately after operation（P〈0.05）; immediately after operation, ET in the two groups was statistically significantly higher than that before operation, respectively（P〈0.05）. Conclusion Nifedipine can effectively improve the endothelium-dependent FMD of radial artery and increase ET in coronary heart disease patients undergoing transradial approach CAG or PCI, but can not effectively improve the endothelium-dependent FMD of brachial artery.