尼可地尔对行经皮冠状动脉介入治疗的心绞痛患者的影响

Impact of Nicorandil on Angina Pectoris Patients Treated by Percutaneous Coronary Intervention

目的分析尼可地尔对行经皮冠状动脉介入治疗(PCI)的心绞痛患者的影响。方法选取2017年3月-2018年8月在西安市第九医院心血管内科行PCI的心绞痛患者156例,采用随机数字表法分为对照组(n=78)和观察组(n=78例)。对照组患者PCI前3 d给予阿司匹林+氯吡格雷+阿托伐他汀口服,观察组患者在对照组治疗基础上给予尼可地尔5 mg/次,PCI前3 h改为10 mg;两组患者PCI后均给予低分子肝素3 d,阿司匹林、阿托伐他汀、氯吡格雷1个月。比较两组患者临床疗效、心肌复流状况,PCI前和PCI后24 h心肌损伤指标〔包括心肌肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB〕),PCI前及PCI后1个月炎性因子〔包括C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)〕、血管舒张功能指标〔包括肱动脉血流介导的舒张功能(FMD)、一氧化氮(NO)〕、左心室射血分数(LVEF),PCI后3 d ST段最大压低程度,PCI后1个月运动平板试验总时间,随访6个月主要不良心血管事件(MACE)累积发生率,治疗期间不良反应发生率。结果(1)观察组患者临床疗效优于对照组(P<0.05)。(2)观察组患者校正的TIMI帧数(CTFC)、无复流或慢血流发生率低于对照组(P<0.05)。(3)两组患者PCI前cTnI、CK-MB及PCI后24 h CK-MB比较,差异无统计学意义(P>0.05);PCI后24 h观察组患者cTnI低于对照组(P<0.05)。(4)两组患者PCI前CRP、TNF-α、FMD、NO及LVEF比较,差异无统计学意义(P>0.05);PCI后1个月观察组患者CRP、TNF-α低于对照组,FMD、NO及LVEF高于对照组(P<0.05)。(5)观察组患者PCI后3d ST段最大压低程度低于对照组,PCI后1个月运动平板试验总时间长于对照组(P<0.05)。(6)随访6个月内观察组患者MACE累积发生率低于对照组(P<0.05)。(7)两组患者治疗期间不良反应发生率比较,差异无统计学意义(P>0.05)。结论尼可地尔可有效提高行PCI的心绞痛患者临床疗效,改善患者心肌复流状况及血管舒张功能,减轻心肌损伤及炎性反应,降低MACE累积发生率,且未增加不良反应发生风险。

Objective To analyze the impact of nicorandil on angina pectoris patients treated by percutaneous coronary intervention(PCI).Methods From March 2017 to August 2018,a total of 156 angina pectoris patients undergoing PCI were selected in the Department of Cardiovascular Medicine,the Ninth Hospital of Xi’an,and they were divided into control group and observation group according to random number table method,with 78 cases in each group.Patients in control group were given peroral aspirin,clopidogrel and atorvastatin 3 days before PCI,while patients in observation group were given extra nicorandil(5 mg per time 3 days before PCI and 10 mg per time 3 hours before PCI)based on that of control group;patients in the two groups were given low molecular weight heparin for 3 days after PCI,aspirin,atorvastatin and clopidogrel for 1 month after PCI.Observation index were compared between the two groups,including clinical effect,myocardial reflow condition,indicators of myocardial injury(including cTnI and CK-MB)before PCI and 24 hours after PCI,inflammatorycytokines(including CRP and TNF-α),index of vasodilatation function(including FMD and NO)and LEVF before PCI and 1 month after PCI,the maximum of ST-segment depression 3 days after PCI,total elapsed time of treadmill exercise testing 1 month after PCI,cumulative incidence of major adverse cardiovascular events(MACE)during 6-month follow-up and incidence of adverse reactions during treatment.Results(1)Compared with that in control group,clinical effect in observation group was statistically significantly better(P<0.05).(2)Compared with those in control group,CTFC and incidence of no-reflow or slow-reflow phenomenon in observation group were statistically significantly lower(P<0.05).(3)Compared with those in control group,observation group showed similar c Tn I and CK-MB before PCI,as well as similar CK-MB 24 hours after PCI(P>0.05),but lower c Tn I 24 hours after PCI(P<0.05).(4)Compared with those in control group,observation group showed similar CRP,TNF-α,FMD,NO and LVEF before PCI(P>0.05),lower CRP and TNF-α,higher FMD,NO and LVEF 1 month after PCI(P<0.05).(5)Compared with that in control group,the maximum of ST-segment depression 3 days after PCI in observation group was statistically significantly lower,and total elapsed time of treadmill exercise testing 1 month after PCI was statistically significantly longer(P<0.05).(6)Compared with that in control group,cumulative incidence of MACE during 6-month follow-up in observation group was statistically significantly lower(P<0.05).(7)Compared with that in control group,incidence of adverse reactions in observation group was not statistically significant different during treatment(P>0.05).Conclusion Nicorandil can effectively improve the clinical effect,myocardial reflow condition and vasodilatation function in angina pectoris patients treated by PCI,reduce the myocardial injury,inflammatory reaction and risk of MACE,without increasing risk of adverse reactions.