尼可地尔对急诊PCI术后心肌梗死患者心肌微循环及预后的影响

Effect of Nicorandil on Myocardial Microcirculation and Prognosis in Patients with Myocardial Infarction after Emergency PCI

目的:探讨尼可地尔对经皮冠状动脉介入治疗(PCI)术后心肌梗死患者心功能、心肌微循环的影响。方法:选取2018年1月~2019年1月本院收治的90例行急诊PCI术后心肌梗死患者,随机分为治疗组(45例)和对照组(45例)。对照组PCI术后予以常规治疗,治疗组在对照组基础上予以尼可地尔口服,两组均连续治疗6个月。比较两组心功能[左室射血分数(LVEF)、左室舒张末期内径(LVEDd)、血浆脑钠肽(BNP)]、TIMI血流分级、心肌微循环(血流速度、心肌血流量及毛细血管横截面积总和)、氧化应激及炎症指标[超氧化物歧化酶(SOD)、血清内皮素(ET)及超敏C反应蛋白(hs-CRP)]及主要心血管不良事件(MACE)发生情况。结果:治疗后,治疗组LVEF高于对照组(P<0.05),LVEDd、BNP低于对照组(P<0.05);TIMI血流分级优于对照组(P<0.05);血流速度、心肌血流量及毛细血管横截面积总和均大于对照组(P<0.05);SOD高于对照组(P<0.05),ET、hs-CRP低于对照组(P<0.05);治疗组MACE发生率(6.67%)与对照组(13.33%)比较无统计学差异(P>0.05)。结论:尼可地尔能够改善PCI术后心肌梗死患者心功能及心肌微循环,促进冠状动脉血流量灌注,改善预后。

Objective:To investigate the effects of nicorandil on cardiac function and myocardial microcirculation in patients with myocardial infarction after percutaneous coronary intervention(PCI).Methods:90 patients with myocardial infarction after emergency PCI in our hospital from January 2018 to January 2019 were randomly divided into treatment group(n=45)and control group(n=45).The control group was given routine treatment after PCI,and the treatment group was given nicorandil orally after PCI.Both groups were treated continuously for 6 months.Cardiac function[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDd),plasma brain natriuretic peptide(BNP)],TIMI blood flow grade,myocardial microcirculation(blood flow velocity,myocardial blood flow and total cross-sectional area of capillaries),oxidative stress and inflammatory indexes[superoxide dismutase(SOD),serum endothelin(ET)and high sensitivity C-reactive protein(hs-CRP)]and major adverse cardiovascular events(MACE)were compared between the two groups.Results:After the treatment,LVEF in the treatment group were significantly higher than that in the control group(P<0.05).And LVEDd,BNP in the treatment group were lower than those in the control group(P<0.05).The TIMI blood flow grade in the treatment group was significantly lower than that in the control group(P<0.05).The blood flow velocity,myocardial blood flow and the total cross-sectional area of capillaries in the treatment group were significantly higher than those in the control group(P<0.05).SOD in the treatment group was significantly higher than that in the control group(P<0.05),ET and hs-CRP were significantly lower in the treatment group than that in the control group(P<0.05).There was no significant difference in the incidence of MACE between the treatment group(6.67%)and the control group(13.33%)(P>0.05).Conclusion:Nicorandil can improve cardiac function and myocardial microcirculation,promote coronary blood flow perfusion and improve prognosis in patients with myocardial infarction after PCI.