尼可地尔联合依那普利叶酸片用于急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入术后的疗效观察

Observation on Efficacy of Nicorandil Combined with Enalaprilat Folic Acid Tablets in Patients with Acute ST-segment Elevation Myocardial Infarction After Emergency Percutaneous Coronary Intervention

目的:探讨尼可地尔联合依那普利叶酸片对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者急诊经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后心肌损伤、同型半胱氨酸(Hcy)及预后的影响。方法:选取2018年2月至2019年10月于哈励逊国际和平医院住院的STEMI患者300例,采用随机数字表法分为A、B及C组,每组100例。A组患者给予依那普利片10 mg,1日1次,口服;B组患者给予依那普利叶酸片10.8 mg,1日1次,口服;C组患者给予尼可地尔5 mg,1日3次+依那普利叶酸片10.8 mg,1日1次,口服。三组患者均行急诊PCI治疗,观察3个月。检测三组患者PCI术前及PCI术后血清肌钙蛋白Ⅰ(cTnⅠ)、Hcy水平,对比心电图变化,记录3个月内主要心脏不良事件发生情况、再住院率。结果:B组、C组患者PCI术后3、7及10 d的cTnⅠ水平明显低于A组,C组患者PCI术后10 d的cTnⅠ水平明显低于B组;C组患者PCI术后7、10 d心电图相关导联抬高ST段回落>50%峰值的发生率高于A组、B组,差异均有统计学意义(P<0.05)。B组、C组患者治疗4、8及12周后的Hcy水平明显低于A组,C组患者治疗8、12周后的Hcy水平明显低于B组,差异均有统计学意义(P<0.05)。C组患者再住院率及再发心绞痛的发生率明显低于A组、B组,差异均有统计学意义(P<0.05)。结论:尼可地尔联合依那普利叶酸片能够减轻心肌损伤,降低Hcy水平,降低STEMI患者急诊PCI术后3个月内的主要心脏不良事件发生率,改善预后。

OBJECTIVE:To probe into the effect of nicorandil combined with Enalaprilat folic acid tablets on myocardial damage,homocysteine and prognosis in patients with acute ST-segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).METHODS:Totally 300 patients with STEMI admitted into Harrison International Peace Hospital from Feb.2018 to Oct.2019 were selected and randomly divided into group A,group B and group C,with 100 cases in each.The group A was treated with 10 mg of Enalaprilat tablets orally for once a day;group B was treated with 10.8 mg of Enalaprilat folic acid tablets orally for once a day;group C was given 5 mg of nicorandil for three times a day combined with 10.8 mg of Enalaprilat folic acid tablets for once a day.All three groups were given emergency PCI and observed for 3 months.The cTnⅠand Hcy levels of three groups before and after PCI were detected,changes of electrocardiogram were compared,major adverse cardiac events and rehospitalization rates within 3 months were recorded.RESULTS:The cTnⅠlevels of group B and group C were significantly lower than those of group A at 3,7,and 10 days after PCI,and the cTnⅠlevel of group C was significantly lower than that of group B at 10 days after PCI;the incidence of ST-segment fall>50%peak in ECG-related leads of group C was higher than that of group A and group B at 7 and 10 days after PCI,with statistically significant differences(P<0.05).The Hcy levels of group B and group C were significantly lower than those of group A at 4,8 and 12 weeks after treatment,the Hcy level of group C was significantly lower than that of group B at 8 and 12 weeks after treatment,with statistically significant differences(P<0.05).The incidences of rehospitalization and recurrence of anginal of group C were significantly lower than those of group A and group B,with statistically significant differences(P<0.05).CONCLUSIONS:The combination of nicorandil and Enalaprilat folic acid tablets can relieve myocardial damage,reduce Hcy level,reduce the incidence of major adverse cardiac events in STEMI patients within 3 months after emergency PCI,and improve prognosis.