尼可地尔对老年急性ST段抬高型心肌梗死患者介入术后心功能的影响

Effect of nicorandil on cardiac function in elderly acute STEMI patients after PCI

目的观察尼可地尔对老年急性ST段抬高型心肌梗死(STEMI)患者直接PCI后心功能的影响。方法将接受直接PCI的STEMI患者100例随机分为尼可地尔组49例和对照组51例。观察2组PCI术后心肌血流灌注指标,评价住院期间及随访6个月心功能。结果与对照组比较,尼可地尔组PCI术后TIMI 3级血流(93.9%vs80.4%)、肌酸激酶同工酶(CK-MB)达峰时间<14h(87.8%vs 70.6%)及ST段回落(85.7%vs 68.6%)显著升高,再灌注心律失常比例(40.8%vs 60.8%)、校正TIMI帧计数及CK-MB峰值降低(P<0.05,P<0.01)。尼可地尔组随访6个月B型钠尿肽(BNP)、左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)低于对照组,LVEF高于对照组(P<0.05,P<0.01)。与住院期间比较,对照组随访6个月BNP、LVEDVI、LVESVI升高(P<0.05);尼可地尔组BNP降低、LVEF升高(P<0.05)。对照组随访6个月MACE发生率高于尼可地尔组(47.1%vs 26.5%,P=0.034)。结论尼可地尔改善老年STEMI患者直接PCI术后心功能。

Objective To study the effect of nicorandil on cardiac function in elderly acute STEMI patients after PCI.Methods One hundred STEMI patients undergoing PCI were divided into nicorandil treatment group（n=49）and control group（n=51）.Their coronary blood flow and myocardial perfusion were recorded after PCI and their cardiac function was assessed during the hospital stay period and 6-month follow-up period.Results The rate of TIMI 3 blood flow,CK-MB peak time14 hand ST-segment resolution was significantly higher while the incidence of reperfusion arrhythmia,CTFC and peak value of CK-MB were significantly lower in nicorandil treatment group than in control group（P〈0.05,P〈0.01）.The serum BNP level,LVEDVI and LVESVI were significantly lower while the LVEF was significantly higher in nicorandil treatment group than in control group during the 6-month follow-up period（P〈0.05,P〈0.01）.The serum BNP level,LVEDVI and LVESVI were significantly higher in control group during the 6-month follow-up period than during the hospital stay period（P〈0.05）.The serum BNP level was significantly lower while the LVEF was significantly higher in nicorandil treatment group during the6-month follow-up period than during the hospital stay period（P〈0.05）.Conclusion Nicorandil can improve the cardiac function in elderly acute STEMI patients after PCI.