尼可地尔对NST-ACS患者PCI术中无复流/慢血流的影响及短期预后探讨

The Effect of Nicorandil on No-reflow/slow Blood Flow during PCI in Patients with NST-ACS and the Short-term Prognosis

目的探讨尼可地尔对NST-ACS患者PCI术中无复流/慢血流的影响及短期预后观察。方法随机选取2019年5月—2020年5月该院行冠脉介入治疗(PCI)的非ST段抬高型急性冠脉综合征(NST-ACS)200例为研究对象,以单双号分组原则划定予以二级预防药物常规治疗的对照组(单号,n=100例)及对照组基础上行尼可地尔治疗的观察组(双号,n=100例),比较两组术中无复流/慢血流(NR/SF)相关情况、心肌损伤状况及主要心脏不良事件(MACE)发生率。结果观察组TIMI TFG三级发生率为92.00%,高于对照组的82.00%,差异有统计学意义(χ^(2)=4.421,P=0.036);观察组cTFC与对照组相比更低,差异有统计学意义(t=3.673,P<0.001),观察组NR/SF发生率为18.00%,较之对照组的33.00%更低,差异有统计学意义(χ^(2)=5.922,P=0.015);两组术前CK-MB、cTnI水平差异无统计学意义(tCK-MB=0.067,PCK-MB=0.947;tcTnI=1.229,PcTnI=0.221),两组术后24 hCK-MB、cTnI水平均有不同程度上升,且于该时间段陆续抵达峰值,差异有统计学意义(P<0.05),术后48 h两组较术后24 hCK-MB、cTnI水平均有回落,但对照组仍处于较高水平,两者比较,差异有统计学意义(tCK-MB=4.281,PCK-MB<0.001;tcTnI=7.050,PcTnI<0.001);观察组MACE发生率低于对照组,差异有统计学意义(χ^(2)=15.672,P<0.001);观察组不良反应发生率为5.00%,低于对照组的23.00%,差异有统计学意义(χ^(2)=13.455,P<0.001)。结论行PCI手术治疗NST-ACS患者施以尼可地尔药物治疗,NR/SF情况显著改善、心肌损伤极大降低,MACE及不良反应发生率有所降低,具有良好短期预后效果。

Objective To investigate the effect of nicorandil on no-reflow/slow blood flow during PCI in NST-ACS patients and the short-term prognosis.Methods 200 cases of non-ST-segment elevation acute coronary syndrome(NST-ACS)who underwent coronary interventional therapy(PCI)in the hospital from May 2019 to May 2020 were random selected as the research subjects,and were divided into single and double numbers.In principle,the control group(single number,n=100 cases)given conventional treatment with secondary preventive drugs and the observation group(double number,n=100 cases)treated with nicorandil on the basis of the control group,compared during the operation of the non-reflow/slow blood flow(NR/SF)related conditions,myocardial injury status,and the incidence of major adverse cardiac events(MACE).Results The incidence of TIMI TFG grade 3 in the observation group was 92.00%,which was higher than 82.00%in the control group,the difference was statistically significant(χ^(2)=4.421,P=0.036);the observation group had a lower cTFC than the control group,the difference was statistically significant(t=3.673,P<0.001).The incidence of NR/SF in the observation group was 18.00%,which was lower than 33.00%in the control group,the difference was statistically significant(χ^(2)=5.922,P=0.015);there was no statistically significant difference in the levels of CK-MB and cTnI between the two groups before operation(tCK-MB=0.067,PCK-MB=0.947;tcTnI=1.229,PcTnI=0.221),the levels of CK-MB and cTnI increased to varying degrees at 24 h postoperatively in the two groups,and reached the peak value in this time period,the difference was statistically significant(P<0.05),the levels of CK-MB and cTnI at 48 h after the operation in the two groups both dropped compared that at 24 h,but the control group was still at a higher level.The difference between the two was statistically significant(tCK-MB=4.281,PCK-MB<0.001;tcTnI=7.050,PcTnI<0.001);the incidence of MACE in the observation group was lower than the control group,the difference was statistically significant(χ^(2)=15.672,P<0.001);adverse reactions occurred in the observation group was 5.00%,which was lower than 23.00%in the control group,the difference was statistically significant(χ^(2)=13.455,P<0.001).Conclusion NST-ACS patients undergoing PCI surgery treated with nicorandil,the NR/SF situation is significantly improved,myocardial damage is greatly reduced,the incidence of MACE and adverse reactions is reduced,and it has a good short-term prognostic effect.