体外反搏联合尼可地尔治疗冠脉微循环障碍疗效及对血管内皮功能的影响

Efficacy of External Counter-Pulsation Combined with Nicorandil on Coronary Microcirculation Disorders and Its Effectson Vascular Endothelial Function

目的:探究体外反搏(ECP)联合尼可地尔治疗冠脉微循环障碍疗效及对血管内皮功能的影响。方法:选取2017年4月至2019年3月我院240例冠脉微循环障碍心绞痛患者为研究对象,采用简单随机分组法分为常规治疗组(对照组)、ECP治疗组(ECP组)、尼可地尔治疗组(尼可地尔组)、ECP联合尼可地尔治疗组(联合组),各60例。记录四组治疗6个月后心绞痛临床疗效、心电图临床疗效,并比较四组治疗前及治疗6个月后平板运动试验阳性率、室壁运动异常发生率、6min步行距离(6MWT)、心肌声学造影指标、心肺功能差异。结果:尼可地尔组与ECP组心绞痛临床疗效及心电图临床疗效比较,差异无统计学意义(P>0.05);联合组心绞痛临床疗效、心电图临床疗效明显高于尼可地尔组、ECP组及对照组(P<0.05),尼可地尔组及ECP组心绞痛临床疗效、心电图临床疗效高于对照组(P<0.05)。治疗6个月后,四组平板运动试验阳性率及室壁运动异常发生率均较治疗前降低(P<0.05),且联合组低于尼可地尔组、ECP组及对照组(P<0.05),尼可地尔组及ECP组低于对照组(P<0.05);四组6MWT及A值、β值、MBF均较治疗前升高(P<0.05),且联合组升高幅度大于尼可地尔组、ECP组及对照组(P<0.05),尼可地尔组及ECP组升高幅度大于对照组(P<0.05)。对照组治疗前后PVO2、AT、PW比较,差异无统计学意义(P>0.05);治疗6个月后,联合组、尼可地尔组及ECP组PVO2、AT、PW均较治疗前升高(P<0.05),且联合组升高幅度大于尼可地尔组、ECP组及对照组(P<0.05),尼可地尔组及ECP组升高幅度大于对照组(P<0.05)。结论:尼可地尔与ECP联合治疗冠脉微循环障碍心绞痛效果显著,对患者内皮功能及微循环灌注改善均较好,临床应用价值高。

Objective:To explore the efficacy of external counter-pulsation(ECP)combined with nicorandil on coronary microcirculation disorders and its effects on vascular endothelial function.Methods:From April 2017 to March 2019,240 patients with coronary microcirculation disorders and angina pectoris in our hospital were selected as the research objects,and they were divided into conventional treatment group(control group),ECP treatment group(ECP group),nicorandil treatment group(nicorandil group)and ECP combined with nicorandil treatment group(combined group)according to the simple random grouping method,with 60 cases in each group.The clinical efficacy of angina pectoris and clinical efficacy of electrocardiogram were recorded among the four groups after 6 months of treatment,and the positive rate of treadmill exercise test,incidence rate of abnormal wall motion,6-minute walking distance(6MWT),myocardial contrast echocardiography indexes and cardiopulmonary function were compared among the four groups before treatment and after 6 months of treatment.Results:There were no statistically significant differences in the clinical efficacy of angina pectoris and clinical efficacy of electrocardiogram between nicorandil group and ECP group(P>0.05).The clinical efficacy of angina pectoris and clinical efficacy of electrocardiogram in combined group were significantly higher than those in nicorandil group,ECP group and control group(P<0.05),and the clinical efficacy of angina pectoris and clinical efficacy of electrocardiogram in nicorandil group and ECP group were higher than those in control group(P<0.05).6 months after treatment,the positive rate of treadmill exercise test and the incidence rate of abnormal wall motion in the four groups were lower than those before treatment(P<0.05),and the two indexes in combined group were lower than those in nicorandil group,ECP group and control group(P<0.05),and the two indexes in nicorandil group and ECP group were lower than those in control group(P<0.05).The 6MWT and A value,βvalue and MBF in the four groups were higher than those before treatment(P<0.05),and the increases in combined group were greater than those in nicorandil group,ECP group and control group(P<0.05).And the increases in nicorandil group and ECP group were greater than those in control group(P<0.05).There were no significant differences in the PVO2,AT and PW in control group before and after treatment(P>0.05).6 months after treatment,the PVO2,AT and PW in combined group,nicorandil group and ECP group were higher than those before treatment(P<0.05),and the increases in combined group were greater than those in nicorandil group,ECP group and control group(P<0.05),and the increases in nicorandil group and ECP group were greater than those in control group(P<0.05).Conclusion:The combination of nicorandil and ECP has a significant effect in the treatment of coronary microcirculation disorders with angina pectoris.It improves the endothelial function and microcirculation perfusion of patients,and has high clinical application value.