尼可地尔用于老年急性心肌梗死合并糖尿病患者PCI术后的价值

Value of Nicorandil after PCI in Elderly Patients with Acute Myocardial Infarction and Diabetes

【目的】探讨尼可地尔用于老年急性心肌梗死合并糖尿病患者经皮冠状动脉介入术(PCI)后的应用价值。【方法】回顾性分析98例行PCI治疗的老年急性心肌梗死合并糖尿病患者的临床资料,根据是否服用尼可地尔将其分为观察组(常规治疗+尼可地尔)与对照组(常规治疗),每组49例。比较两组患者术后的心肌梗死溶栓试验(TIMI)血流分级,比较术前及术后24 h的肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI),比较两组患者治疗前后的左室射血分数(LVEF)、左室收缩末内径(LVESD)、左室舒张末内径(LVEDD)、糖化血红蛋白(HbA1c)、空腹血糖(FPG)、餐后2 h血糖(2hPG),术后随访6个月,记录患者发生不良心脏事件的情况。【结果】观察组TIMI血流分级情况优于对照组,差异有统计学意义(P<0.05)。术后24 h,两组CK-MB、cTnI高于术前,但观察组低于对照组(P<0.05)。两组治疗后LVEF显著高于治疗前,LVESD、LVEDD显著低于治疗前(P<0.05),且观察组与对照组比较,差异均有统计学意义(P<0.05)。两组治疗后HbA1c、FPG、2hPG低于治疗前(P<0.05),但观察组与对照组比较差异无统计学意义(P>0.05)。观察组不良心脏事件总发生率显著低于对照组(P<0.05)。【结论】尼可地尔用于老年急性心肌梗死合并糖尿病患者PCI术后可改善微循环灌注,减轻心肌损伤,并改善心功能,减少不良心脏事件的发生。

【Objective】To explore the application value of Nicorandil in elderly patients with acute myocardial infarction and diabetes after percutaneous coronary intervention(PCI).【Methods】The clinical data of 98 elderly patients with acute myocardial infarction and diabetes treated by PCI were retrospectively analyzed.They were divided into the observation group(routine treatment+Nicorandil)and the control group(routine treatment)according to whether they took Nicorandil or not,with 49 cases in each group.The blood flow grades of myocardial infarction thrombolysis test(TIMI),creatine kinase isoenzyme(CK-MB)and troponin I(cTnI)before and 24 hours after operation were compared between the two groups;The left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDD),glycosylated hemoglobin(HbA1c),fasting blood glucose(FPG),and postprandial blood glucose(2hPG)of the two groups were also compared before and after treatment.The patients were followed up for 6 months to record the adverse cardiac events.【Results】The TIMI blood flow grading in the observation group was better than that in the control group,with a statistically significant difference(P<0.05).At 24 hours after operation,CK-MB and cTnI in the two groups were higher than those before operation,but those in the observation group were lower than those in the control group(P<0.05).LVEF after treatment was significantly higher than that before treatment,LVESD and LVEDD were significantly lower than that before treatment(P<0.05),and the difference between the observation group and the control group was statistically significant(P<0.05).After treatment,HbA1c,FPG and 2hPG in the two groups were lower than those before treatment(P<0.05),but there was no significant difference between the observation group and the control group(P>0.05).The total incidence of adverse cardiac events in the observation group was significantly lower than that in the control group(P<0.05).【Conclusion】Nicorandil can improve microcirculation perfusion,alleviate myocardial injury,improve cardiac function and reduce adverse cardiac events in elderly patients with acute myocardial infarction and diabetes after PCI.