尼可地尔对急性ST段抬高型心肌梗死患者直接PCI术后心肌微循环的影响

The Effect of Nicorandil on Myocardial Microcirculation after Direct PCI in Patients with Acute ST-segment Elevation Myocardial Infarction

目的探讨尼可地尔对急性ST段抬高型心肌梗死患者直接PCI术后心肌微循环的影响。方法选择2018年7月—2020年5月收治的84例急性ST段抬高型心肌梗死患者进行研究,根据给药方案不同分为对照组与观察组,每组42例,对照组PCI术中冠脉注射生理盐水并持续泵入24 h,观察组PCI术中冠脉注射尼可地尔并静脉泵入24 h,对两组心肌微循环及心功能指标、血管内皮功能进行比较。结果观察组PCI术后TIMI血流3级占比95.24%,慢血流/无血流占比4.76%、CTFC为(24.96±3.75)帧,优于对照组,差异有统计学意义(χ^(2)=4.087、4.087,t=4.697,P<0.05);观察组PCI术后血清内皮素(ET)、一氧化氮(NO)水平分别为(61.35±5.96)ng/L、(73.65±3.75)μmol/L,优于对照组,差异有统计学意义(t=14.767、17.776,P<0.05);两组术后12 h的左室射血分数(LVEF)、左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)差异无统计学意义(P>0.05),术后3 d时,观察组的LVEF、LVEDD、LVESD分别为(56.98±5.24)%、(46.89±3.25)mm、(26.78±1.05)mm,明显优于对照组,差异有统计学意义(t=8.077、8.993、20.917,P<0.05)。结论尼可地尔可促进急性ST段抬高型心肌梗死患者PCI术后心肌微循环改善,也能改善血管内皮功能及心功能。

Objective To investigate the effect of nicorandil on myocardial microcirculation after direct PCI in patients with acute ST-segment elevation myocardial infarction.Methods A total of 84 patients with acute ST-segment elevation myocardial infarction admitted from July 2018 to May 2020 were selected for the study.According to the different dosing regimens,they were divided into control group and observation group,42 cases in each group.In the control group,intra-PCI coronary artery normal saline was injected and continuously pumped for 24 hours.In the observation group,nicorandil was injected into the coronary artery and intravenously pumped for 24 hours during PCI.The myocardial microcirculation,cardiac function indexes,and vascular endothelial function were compared between the two groups.Results In the observation group after PCI,the TIMI blood flow level 3 accounted for 95.24%,the slow blood flow/no blood flow accounted for 4.76%,and the CTFC was(24.96±3.75)frames,which was better than the control group.The difference was statistically significant(χ^(2)=4.087,4.087,t=4.697,P<0.05);serum endothelin(ET)and nitric oxide(NO)levels in the observation group after PCI were(61.35±5.96)ng/L and(73.65±3.75)μmol/L,respectively,which were better than the control group,the difference was statistically significant(t=14.767,17.776,P<0.05);There was no significant difference in the left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),left ventricular end-systolic diameter between the two groups(LVESD)(P>0.05).At 3 days postoperatively,the LVEF,LVEDD,LVESD of the observation group were(56.98±5.24)%,(46.89±3.25)mm,(26.78±1.05)mm,respectively,which were significantly better than the control group,and the difference was statistically significant(t=8.077,8.993,20.917,P<0.05).Conclusion Nicorandil can promote the improvement of myocardial microcirculation after PCI in patients with acute ST-segment elevation myocardial infarction,and it can also improve vascular endothelial function and cardiac function.