口服尼可地尔对老年STEMI患者急诊PCI围术期心肌保护作用的临床研究

Perioperative myocardial protection of oral administration of nicorandil for senile STEMI patients undergoing emergency PCI

目的评估口服尼可地尔对老年多支病变ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉介入术(PCI)围术期的心肌保护作用。方法以2015年4月至2016年12月我院心内科收治的129例急诊PCI患者为研究对象,按照随机数字分为观察组(65例)和对照组(64例),对照组行常规急诊PCI治疗并围术期用药,观察组在对照组基础上入院加服尼可地尔,每次5 mg,3次/d,比较两组PCI术中血液灌注情况、术后血清学心肌损伤标志物、超声心动图指标及不良心血管事件。结果观察组支架植入后即刻梗死相关动脉达到TIMI3级血流比例(96.9%vs.90.6%)、心肌3级染色比例(90.8%vs.82.8%)及术后2 h ST段回落比例(86.2%vs.76.6%)均高于对照组,但差异均无统计学意义(P>0.05)。观察组术后24 h CK-MB[(33.8±4.9)U/L vs.38.1±6.0)U/L]、c Tn I[(67.7±23.8)ng/m L vs.(79.3±27.1)ng/m L]、BNP[(328.2±51.1)pg/m L vs.(362.3±56.3)pg/m L]、hs-CRP[(6.8±2.0)mg/L vs.(8.1±2.7)mg/L]均显著低于对照组(P<0.05);观察组术后72 h CK-MB曲线下面积略低于对照组[(3 892.3±784.5)U·h/L vs.4 147.5±923.3)U·h/L](P>0.05)。观察组、对照组术后7 d LVEF(14.8%±3.7%vs.13.6%±3.8%)、PER[(0.27±0.08)EDV/s vs.(0.26±0.06)EDV/s]、LVESVI[(22.1±5.8)m L/m2vs.(20.4±5.1)m L/m^2]、LVEDVI[(19.0±4.7)m L/m2vs.(18.2±4.5)m L/m^2]与术前比较差异均无统计学意义(P>0.05)。两组住院期间不良心血管事件发生率比较差异无统计学意义(P>0.05)。结论老年多支病变STEMI患者急诊PCI围术期加服尼可地尔能减轻心肌缺血再灌注损伤,但短期不足以达到显著减轻梗死面积、改善心功能的作用。

Objective To assess the perioperative myocardial protection of oral administration of nicorandil for senile patients with multivessel ST-segment elevation myocardial infarction undergoing emergency percutaneous coronary intervention（ PCI）. Methods Totally 129 patients undergoing PCI from April 2015 to December 2016 were divided into observation group（ n = 65） and control group（ n = 64） according to random number,control group with routine emergency PCI and perioperative treatment,observation group added with nicorandil on admission,5 mg per time,tid,blood perfusion during PCI,perioperative serum markers of myocardial injury and adverse cardiovascular events of the 2 groups were compared. Results Observation group immediately after stent implantation with ratio of grade 3 TIMI（ 96. 9% vs.90. 6%）,grade 3 myocardial staining（ 90. 8% vs. 82. 8%） and 50% ST-segment drop 2 h after PCI（ 86. 2% vs.76. 6%） were slightly higher than control group,but the differences were not statistically significant（ P〉0. 05）. At 24 h after PCI,the CK-MB[（ 33. 8 ± 4. 9） U/L vs.（ 38. 1 ± 6. 0） U/L],c Tn I[（ 67. 7 ± 23. 8） ng/m L vs.（ 79. 3 ± 27. 1） ng/m L],BNP[（ 328. 2 ± 51. 1） pg/m L vs.（ 362. 3 ± 56. 3） pg/m L],and hs-CRP[（ 6. 8 ± 2. 0） mg/L vs.（ 8. 1 ± 2. 7） mg/L]of observation group were significantly lower than those of control group（ P〈0. 05）. The area under the CK-MB curves within 72 h of observation group was lower than that of control group [（ 3 892. 3 ± 784. 5） U·h/L vs.（ 4 147. 5 ± 923. 3）U·h/L]（ P〈0. 05）. The variations of the 2 groups on LVEF（ 14. 8% ± 3. 7% vs. 13. 6% ± 3. 8%）,PER [（ 0. 27 ±0. 08） EDV/s vs.（ 0. 26 ± 0. 06） EDV/s ],LVESVI [（ 22. 1 ± 5. 8） m L/m^2 vs.（ 20. 4 ± 5. 1） m L/m^2],and LVEDVI[（ 19. 0 ± 4. 7） m L/m^2 vs.（ 18. 2 ± 4. 5） m L/m^2]7 d after operation with no statistically significant differences（ P〉0. 05）. There was no significant differences in the incidences of adverse cardiovascular events between the 2 groups（ P〉0. 05）. Conclusion Oral administration of nicorandil on admission can help to relieve perioperative myocardial injury for senile patients with STEMI undergoing PCI,however,the short-term efficacy do not enough to reduce infarct size and improve cardiac function significantly.