尼可地尔联合单硝酸异山梨酯对急性心肌梗死介入治疗患者心肌微循环灌注的影响

Efficacy of Nicorandil combined with Isosorbide Mononitrate on myocardial microcirculation perfusion in patients with acute myocardial infarction

目的探讨尼可地尔联合单硝酸异山梨酯在急性心肌梗死介入治疗患者中的应用效果和安全性。方法选取2018年1月~2020年1月南宁市第二人民医院收治的86例急性心肌梗死患者作为研究对象,按随机数字表法将其分为对照组与观察组,每组各43例。对照组患者于介入治疗后予以单硝酸异山梨酯,观察组患者在对照组的基础上于入院时和介入治疗后加用尼可地尔治疗。比较两组患者的心功能、心肌微循环灌注、血清学指标和不良反应发生情况。结果术前两组患者的心功能指标比较,差异无统计学意义(P>0.05);术后30 d两组患者的左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)低于术前,左室射血分数(LVEF)高于术前,差异有统计学意义(P<0.05);术后30 d观察组患者的LVEDD、LVESD为(43.16±3.82)、(34.67±3.81)mm,低于对照组的(47.65±3.98)、(38.28±3.94)mm,LVEF为(54.41±4.62)%,高于对照组的(50.39±4.53)%,差异有统计学意义(P<0.05)。观察组患者的毛细血管横截面积之和、血流速度、心肌血流量为(15.42±1.75)cm2、(0.79±0.16)cm/s、(12.03±1.53)L/min,高于对照组的(13.95±1.68)cm2、(0.72±0.14)cm/s、(10.21±1.42)L/min,差异有统计学意义(P<0.05)。术前两组患者的血清学指标比较,差异无统计学意义(P>0.05);术后24 h两组患者的肌钙蛋白I(cTnI)、氨基末端脑钠肽前体(NT-proBNP)高于术前,差异有统计学意义(P<0.05);术后24 h观察组患者的cTnI、NT-proBNP为(60.14±7.25)μg/L、(769.35±70.16)ng/L,低于对照组的(69.43±7.36)μg/L、(903.41±81.53)ng/L,差异有统计学意义(P<0.05)。两组患者的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论尼可地尔联合单硝酸异山梨酯可改善急性心肌梗死介入治疗患者的心肌微循灌注,加快心功能恢复,降低cTnI、NT-proBNP水平,安全可靠。

Objective To investigate the efficacy and safety of Nicorandil combined with Isosorbide Mononitrate in patients with acute myocardial infarction undergoing interventional therapy.Methods A total of 86 patients with acute myocardial infarction admitted to the Second Nanning People′s Hospital from January 2018 to January 2020 were selected as the research subjects.According to random number table method,they were divided into the control group and the observation group,with 43 cases in each group.The control group received Isosorbide Mononitrate after interventional therapy,and the observation group was additively treated with Nicordil at admission and after interventional therapy.Cardiac function,myocardial microcirculation perfusion,serological indexes and the incidence of adverse reactions were compared between the two groups.Results There was no statistically significant difference in the cardiac function between the two groups before operation(P>0.05).At 30 days after surgery,the left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD)of the two groups were lower than those before surgery,the left ventricular ejection fraction(LVEF)was higher than that before surgery,and the differences were statistically significant(P<0.05).At 30 days after surgery,the LVEDD and LVESD in the observation group were(43.16±3.82)and(34.67±3.81)mm,lower than(47.65±3.98)and(38.28±3.94)mm in the control group,the LVEF was(54.41±4.62)%,higher than(50.39±4.53)%in the control group,and the differences were statistically significant(P<0.05).The sum of capillary cross-sectional area,blood flow velocity and myocardial blood flow in observation group were(15.42±1.75)cm2,(0.79±0.16)cm/s and(12.03±1.53)L/min,which were higher than(13.95±1.68)cm2,(0.72±0.14)cm/s and(10.21±1.42)L/min in control group,and the differences were statistically significant(P<0.05).There were no statistically significant differences in preoperative serum indexes between the two groups before operation(P>0.05).The 24 h postoperative levels of troponin I(cTnI)and N-terminal pro-brain natriuretic peptide(NT-proBNP)were higher than those before operation in the two groups,and the differences were statistically significant(P<0.05).The 24 h postoperative levels of cTnI and NT-proBNP in the observation group were(60.14±7.25)μg/L and(769.35±70.16)ng/L,which were lower than(69.43±7.36)μg/L and(903.41±81.53)ng/L in the control group,and the differences were statistically significant(P<0.05).There was no statistically significant differences in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Nicorandil combined with Isosorbide Mononitrate improves myocardial microcirculation perfusion in patients undergoing interventional therapy for acute myocardial infarction,which accelerates the recovery of cardiac function and reduces the levels of cTnI and NT-proBNP.It is safe and reliable.