美托洛尔联合尼可地尔对经皮冠状动脉介入术后患者心肌和血管内皮的保护作用

The protective effect of metoprolol combined with nicorandil on myocardial and vascular endothelium after percutaneous coronary intervention

目的探讨美托洛尔联合尼可地尔治疗对ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)行经皮冠状动脉介入(PCI)术后患者的心肌和血管内皮的保护作用。方法选取2015年1月至2017年6月在兰州市4家医院确诊的ST段抬高型心肌梗死行PCI术治疗的患者142例作为研究对象,按照随机数字表法分为实验组和对照组,每组71例。对照组患者在PCI术中通过冠脉注射尼克地尔2 mg,随后静脉滴注尼克地尔(4 mg/h)至术后36 h;实验组患者除在术中同对照组一样给予尼克地尔外,在术前12 h开始口服美托洛尔12.5 mg,1次/12 h,持续至术后48 h。比较两组患者术后24 h,48 h和72 h心肌肌钙蛋白I(c Tn I)、血管性血友病因子(v WF)和血管内皮生长因子(VEGF)的变化情况以及不良反应发生情况。结果不同治疗方法的两组患者的c Tnl、VEGF水平比较差异有统计学意义(P<0.05)、v WF水平比较差异无统计学意义(P>0.05);不同时间两组患者的c Tnl、v WF、VEGF水平比较差异有统计学意义(P<0.05)。两组患者c Tnl、v WF、VEGF水平在不同时间的变化趋势不同,两组患者的c Tn I、v WF水平均在PCI术后急剧升高,24 h后开始下降,实验组患者的c Tn I、v WF水平变化较对照组明显;两组患者的VEGF水平在PCI术后开始升高,在PCI术后72 h达到高峰,实验组患者VEGF水平的变化较对照组更为显著。两组患者不良反应发生率分别为9.86%和7.04%,差异无统计学意义(P>0.05)。结论美托洛尔联合尼克地尔治疗STEMI患者可降低心肌细胞受损程度,促进内皮细胞生成。

Objective To investigate the protective effect of metoprolol combined with nicorandil on myocardial and vascular endothelium, which patients had ST segment elevation（ STEMI） undergoing percutaneous coronary intervention（ PCI）.Methods 142 patients with STEMI diagnosed in 4 hospitals of Lanzhou from January 2015 to June 2017 were treated with PCI,which was divided into the experimental group and the control group according to the random number table method,with 71 cases in each group. The control group received nicorandil 2 mg by intracoronary injection during the PCI,and intravenous infusion of nicorandil（4 mg/h） to 36 th hour after operation The experimental group began to take oral metoprolol 12. 5 mg every 12 hours begin with 12 h hours before operation to 48 h after operation on the basis of the treatment in the control group. The changes of 24 h,48 h and 72 h of cardiac troponin I（ cTnI）,von Willebrand factor（ v WF） and vascular endothelial growth factor（ VEGF） and the incidence of adverse reactions were compared between the two groups after operation. Result The difference of cTnI and VEGF between the two groups was statistically significant（ P〈0. 05）. There was no significant difference in v WF level（ P〈0. 05）. There were significant differences in cTnI,v WF and VEGF levels in two groups,which collect at different time（ P〈0. 05）. The changes in the levels of cTnI,v WF and VEGF in the two groups were different at different times. The levels of cTnI and v WF in the two groups were all increased sharply after PCI and fell after 24 h. The level of cTnI and v WF in the experimental group was significantly higher than that in the control group. The level of VEGF in the two groups began to rise after PCI,and reached a peak at 72 th hour after PCI. The changes of VEGF level in the experimental group were more significant than those in the control group. The incidence of adverse reactions in the two groups was 9. 86% and 7. 04%,and the difference was not statistically significant（ P〈0. 05）.Conclusion Metoprolol combined with nicorandil treatment can reduce myocardial cell damage in STEMI patients,promote endothelial cell generation.