曲美他嗪联合尼可地尔治疗缺血性心肌病患者心力衰竭的临床观察

Clinical Observation of Trimetazidine Combined with Nicorandil in the Treatment of Ischemic Cardiomyopathy with Heart Failure

目的观察曲美他嗪联合尼可地尔在缺血性心肌病(ischemic cardiomyopathy,ICM)患者心力衰竭治疗中的应用效果。方法将2018年1月-12月收治的ICM心力衰竭患者90例作为研究对象,分为观察组及对照组,两组均给予常规治疗。观察组患者给予曲美他嗪联合尼可地尔治疗,对照组患者仅给予曲美他嗪口服治疗,治疗3个月后对比两组治疗前后血浆钠尿肽(BNP)、C反应蛋白(CRP)、肌钙蛋白I(cTnI)、左室射血分数(LVEF)、二尖瓣舒张早期/晚期血流速度峰值(E/A)、二尖瓣舒张早期血流速度峰值/二尖瓣环根部运动速度峰值比(E/Ea);治疗前后进行动态心电图检查,对比两组24 h内ST段下降频次、持续时间,并计算心肌缺血总负荷。结果疗程结束后两组患者cTnI、BNP、CRP水平均低于同组治疗前(P均<0.05),观察组cTnI、BNP、CRP水平均低于同期对照组(P均<0.05);疗程结束后两组患者LVEF、E/A较治疗前上升,E/Ea较治疗前下降(P均<0.05);疗程结束后观察组LVEF、E/A及E/Ea改善均优于对照组(P均<0.05);治疗后两组患者24 h内ST段下降频次、持续时间及心肌缺血总负荷均较治疗前下降(P均<0.05);观察组治疗后24 h内ST段下降频次、持续时间及心肌缺血总负荷均低于对照组(P均<0.05)。结论ICM心力衰竭患者在常规治疗的基础上加用曲美他嗪联合尼可地尔治疗,可有效下调其微炎症反应,改善心脏功能。

Objective To observe the effect of Trimetazidine combined with Nicorandil in the treatment of ischemic cardiomyopathy(ICM)heart failure.Methods Ninety patients with ICM heart failure who were admitted between January 2018 and December 2018 were enrolled in the study.The enrolled patients were divided into observation group and control group.Both groups were routinely treated on admission.The observation group was treated with Trimetazidine combined with Nicorandil on the basis of the control group and treated for three months for the course of treatment.The levels of plasma natriuretic peptide(BNP),C-reactive protein(CRP)and troponin I(cTnI)were compared before and after treatment.The left ventricular ejection fraction(LVEF)and early/late mitral valvular diastolic blood pressure before and after treatment were compared between the two groups.Peak blood flow velocity(E/A),peak blood flow velocity at the early stage of mitral valve relaxation/peak ratio of mitral annulus velocity(E/Ea).Dynamic electrocardiogram were compared before and after treatment.The ST segment was decreased in frequency and duration within 24 hours,and the total myocardial ischemic load was calculated.Results The levels of cTnI,BNP and CRP were lower than those in the same group before treatment(P<0.05).After treatment,the levels of cTnI,BNP and CRP in the observation group were lower than those of the control group(P<0.05).After treatment,LVEF and E/A were compared before the rise(P<0.05),E/Ea decreased compared with before treatment(P<0.05).The improvement of LVEF,E/A and E/Ea in the observation group was better than that in the control group(P<0.05).The frequency,duration and myocardial ischemia total load of ST segment decreased within 24 hours after treatment(P<0.05).The frequency,duration and total myocardial ischemia load of ST segment within 24 hours after treatment were lower than those of the control group(P<0.05).Conclusion The addition of Trimetazidine combined with Nicorandil to patients with ICM heart failure can reduce the microinflammation and improve cardiac function.