静脉注射尼可地尔对不稳定型心绞痛患者PCI术后心脏自主神经功能和心肌微循环的影响

Influence of intravenous injection of nicorandil on cardiac autonomic nerve function and myocardial microcirculation in patients with unstable angina after PCI

目的探讨注射用尼可地尔对不稳定型心绞痛(UA)患者经皮冠状动脉介入治疗(PCI)术后的疗效、心脏自主神经功能及心肌微循环的影响。方法选取2019年1月至2019年12月于郑州市中医院内二科行择期PCI的UA患者146例,按序编号分为对照组和观察组各73例,两组患者均行常规治疗,观察组在PCI术前静脉注射尼可地尔。比较两组患者治疗前后心功能、心肌损伤标志物、炎症因子、心率变异性(HRV)及心肌微循环指标、围手术期心肌损伤(pMI)和心血管不良事件(MACEs)发生情况。结果PCI术后7 d,观察组患者的左室射血分数(LVEF)、RR间期的标准差(SDNN)、窦性R-R间期平均值标准差(SDANN)、相邻R-R间期差值的均方根(RMSSD)、两个相邻R-R间期互差>50 ms的心跳所占分析信息内心跳数的百分数(PNN50)均高于治疗前及对照组(P<0.05),且左室收缩末期内径(LVESd)、左室舒张末期内径(LVEDd)均低于治疗前和对照组(P<0.05);两组患者的肌钙蛋白I(cTnI)、磷酸肌酸激酶同工酶(CK-MB)、超敏C反应蛋白(hs-CRP)均较治疗前降低(P<0.05),且观察组患者心肌损伤指标降低较对照组更明显(P<0.05);PCI术后7 d,观察组患者左前降支(LAD)、左回旋支(LCX)、右冠(RCA)校正时间流帧计数(cTFC)均少于对照组(P<0.05),但TIMI心肌组织灌注分级(TMPG)达到3级标准的比例两组差异不明显(P>0.05);观察组围手术期pMI发生率低于对照组(10.96%vs.2.74%,P<0.05);但两组随访6个月心血管不良事件(MACEs)发生率比较,无统计学差异(P>0.05)。结论静脉注射尼可地可能有效提高UA患者PCI术后的心脏自主神经功能和心肌微循环,增加血流灌注、缓解心肌损伤,对临床改善PCI术后的预后有较高应用价值。

Objective To investigate the influence of intravenous injection of nicorandil on clinical efficacy,cardiac autonomic nerve function and myocardial microcirculation in patients with unstable angina(UA)after percutaneous coronary intervention(PCI).Methods UA patients received planed PCI(n=146)were chosen from the Second Department of Internal Medicine in Zhengzhou Hospital of Traditional Chinese Medicine from Jan.2019 to Dec.2019,and then divided randomly into control group and observation group(each n=73).The patients in 2 groups were treated with symptomatic routine therapies,and observation group was additionally given intravenous injection of nicorandil before PCI.The indexes of heart function,biomarker of myocardial damage,inflammatory factors and heart rate variability(HRV),indexes of myocardial microcirculation,and incidence of perioperative myocardial injury(pMI)and major adverse cardiovascular events(MACE)were compared between 2 groups before and after treatment.Results After PCI for 7 d,LVEF,SDNN,SDANN,RMSSD and PNN50 were all higher in observation group than those in control group and before treatment(P<0.05).LVESd and LVEDd were lower in observation group than those in control group(P<0.05).The levels of cTnI,CK-MB and hs-CRP decreased in 2 groups after treatment(P<0.05),which was more significant in observation group(P<0.05).After PCI for 7 d,the corrected TIMI frame count(cTFC)of LAD,LCX and RCA were less in observation group than those in control group(P<0.05).The difference in percentage of TIMI myocardial perfusion grade(TMPG)reaching grade 3 had no significance between 2 groups(P>0.05).The incidence rate of pMI was lower in observation group than that in control group(10.96%vs.2.74%,P<0.05).The incidence rate of MACE had no statistical difference between 2 group(P>0.05)during follow-up period for 6 months.Conclusion Intravenous injection of nicorandil can effectively improve cardiac autonomic nerve function and myocardial microcirculation,promote blood perfusion and relieve myocardial damage,and has a higher application value to ameliorating prognosis in UA patients after PCI.