术前口服大剂量尼可地尔对急性冠脉综合征患者PCI术中无复流/慢血流的影响及心脏的保护作用评价

Effect of oral high-dose nicorandil on no-reflow/slow-flow in patients with acute coronary syndromes during PCI and its evaluation of cardioprotective effect

目的探讨口服大剂量尼可地尔对急性冠脉综合征(ACS)患者经皮冠状动脉介入(PCI)术中无复流及慢血流的预防效果及远期心脏保护作用。方法收集我院心内科监护室收治的ACS患者120例,随机分为3组,包括对照组(A组),术前静脉注射尼可地尔12 mg(B组)及术前口服尼可地尔20 mg(C组)。3组均给予积极的冠心病综合治疗,B组及C组在综合治疗的基础上于术后第2天加用尼可地尔5 mg,3次/d,口服6个月,平均随访半年。观察3组患者PCI术前及术后的心肌梗死溶栓试验(TIMI)血流分级及校正TIMI血流帧数(cTFC),血清心肌钙蛋白T(cTnT)及血清肌酸激酶同工酶(CK-MB)峰值水平,以及PCI术后1、3及6个月内心脏事件的发生情况(包括再发心绞痛、再发心肌梗死、恶性心律失常、充血性心力衰竭、心因性死亡、非心因性死亡)。结果 B组和C组术后慢血流及无复流的发生率均较对照组显著降低(P < 0.05),C组和B组之间TIMI血流分级及cTFC差异无统计学意义;B组和C组CK-MB、cTnT峰值均较对照组显著降低(P < 0.05),C组和B组CK-MB、cTnT峰值差异无统计学意义;术后3个月B组和C组左室射血分数(LVEF)均较对照组显著增高(P < 0.05),左室舒张末期容积(LVEDV)较对照组显著下降(P < 0.05),而B组和C组之间差异无统计学意义;术后半年B组和C组因慢性心力衰竭入院的比例较A组降低(P<0.05),B组和C组之间无统计学差异。结论 ACS患者PCI术前给予大剂量的尼可地尔及术后持续使用可显著改善术中无复流/慢血流的发生率,减少患者的心肌梗死面积,改善患者心功能。

AIM To investigate whether oral high-dose nicorandil before PCI in acute coronary sysdrome could reduce the incidence of no-reflow/slow-flow and its evaluation of cardioprotective effects. METHODS This follow-up study to 6 months of a randomized, double-blind trial was conducted among 120 patients with acute coronary syndromes. The investigation was randomized to a control group A and a group B receiving 12 mg nicorandil intravenously and a group C receiving 20 mg orally. Mean follow-up was 1.0 years. Each patient received active comprehensive treatment of coronary heart disease. On the basis of comprehensive treatment, group B and group C were given nicorandil 5 mg three times a day for 6 months, with an average follow-up of half a year.The TIMI flow grade of infarct-related artery, corrected TIMI frame count (cTFC), peak levels of serum cTnT and CK-MB, and occurrence of cardiac events (including recurrent angina pectoris, recurrent myocardial infarction, malignant arrhythmia,heart failure,cardiac death, and non cardiac death.) were observed 1 month, 3 months, and 6 months after PCI among the three groups. RESULTS The incidence of slow flow and no-reflow in group B and group C was significanty lower than that in group A (P < 0.05), and there was no significant difference in the TIMI flow grade of infarct -related artery and cTFC between group B and group C. The peaks of CK-MB and cTnT in group B and group C were lower than those in the control group (P < 0.05), but there was no significant difference between group B and group C. LVEF increased in group B and group C at 3 months after operation (P < 0.05), and LVEDV decreased significantly (P < 0.05), but there was no significant difference between group B and group C. The value of the half-year admission by heart failure decreased than that of group A (P < 0.05), and there was no significant difference between group B and group C. CONCLUSION High doses of nicorandil before PCI and continuous use after PCI significantly decreased the incidence of no-reflow/slow flow, and reduced the size of myocardial infarction and improved cardiac function in patients with ACS.