尼可地尔联合替罗非班对老年ST段抬高型心肌梗死患者经皮冠状动脉介入术术后即刻心肌血流灌注和预后的影响

Effect of nicorandil combined with tirofiban on immediate myocardial perfusion and prognosis after percutaneous coronary intervention in elderly patients with ST-elevation myocardial infarction

目的探讨尼可地尔联合替罗非班对老年ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后即刻心肌血流灌注和预后的影响。方法将拟行PCI的88例老年STEMI患者随机分为观察组和对照组,每组44例。对照组术中冠状动脉内及术后48 h内持续静脉滴注替罗非班,观察组在对照组的基础上加用尼可地尔。比较两组术后校正的心肌梗死溶栓(TIMI)血流帧数、慢血流或无复流率、ST段回落率,观察两组术后再灌注心律失常及术后1 d心绞痛发生情况。术后随访3个月,记录两组梗死后心绞痛发生情况及心力衰竭再入院情况。结果观察组术后即刻校正的TIMI血流帧数、慢血流或无复流率低于对照组,ST段完全回落率高于对照组(均P<0.05);观察组术后再灌注心律失常发生率、术后1 d内心绞痛发生率,以及术后3个月内梗死后心绞痛发生率和心力衰竭再入院率均低于对照组(均P<0.05)。结论老年STEMI患者PCI术中联合应用尼可地尔和替罗非班可更好地改善术后即刻心肌血流灌注水平及预后。

Objective To investigate the effect of nicorandil combined with tirofiban on the immediate myocardial perfusion and prognosis after percutaneous coronary intervention(PCI)in the elderly patients with ST-elevation myocardial infarction(STEMI).Methods Eighty-eight elderly STEMI patients scheduled for PCI were selected,and were randomly divided into observation group(n=44)and control group(n=44).The control group was administered tirofiban during operation and within 48 h after operation via coronary artery and continuous intravenous infusion,respectively;additionally,the observation group was administered nicorandil based on the therapeutic schedule of the control group.The corrected thrombolysis in myocardial infarction(TIMI)frame count(cTFC),rate of slow blood flow or no re-flow,rate of ST-segment resolution were compared between the two groups;besides,the occurrence of postoperative reperfusion arrhythmia and angina within 1 day after operation were observed in both groups.Within three-month follow-up,the occurrence of angina after myocardial infarction and the re-admission due to cardiac failure were recorded in both groups.Results The observation group achieved a less immediate cTFC,a lower rate of slow blood flow or no re-flow after operation,and a higher rate of ST-segment resolution compared with the control group(all P<0.05);compared with the control group,the observation group exhibited a lower rate of reperfusion arrhythmia,a incidence rate of angina within 1 day after operation,a incidence rate of angina after myocardial infarction and a readmission rate due to heart failure within 3 months after myocardial infarction(all P<0.05).Conclusion Combined application of nicorandil and tirofiban during PCI can improve immediate postoperative myocardial perfusion level and prognosis in the elderly patients with STEMI.