尼可地尔术前干预对心脏病患者行髋关节置换术的心肌保护作用

The myocardial protective effect of nicorandil preoperative intervention on patients with heart disease undergoing hip arthroplasty

目的:探讨尼可地尔术前干预对心脏病患者行髋关节置换术的心肌保护作用。方法:对2018年6月至2020年12月南通大学附属医院如皋分院117例行髋关节置换术患者的病历资料进行回顾性分析,根据术前是否给予尼可地尔分为两组,A组常规术前全身麻醉,B组于术前给予尼可地尔。比较两组手术相关指标、炎性因子水平、心肌损伤及主要心血管不良事件(MACE)发生情况。结果:两组手术时间、术中出血量、术中补液量、尿量、术后1 d Ramsay镇静评分、术后1 d视觉模拟量表评分、住院时间比较差异无统计学意义(P>0.05)。B组术后血清白细胞介素6、肿瘤坏死因子-α、C反应蛋白、心肌肌钙蛋白I、肌酸激酶同工酶、肌红蛋白、脂蛋白相关磷脂酶A2水平均低于A组[(388.15±56.20)μg/L比(456.34±65.18)μg/L、(34.24±8.90)μg/L比(40.26±10.22)μg/L、(27.54±5.52)mg/L比(30.25±5.61)mg/L、(0.10±0.05)μg/L比(0.19±0.08)μg/L、0.059±0.019比0.099±0.026、(68.41±6.03)μg/L比(76.61±6.54)μg/L、(201.67±25.88)μg/L比(251.37±31.06)μg/L],差异有统计学意义(P<0.05)。两组MACE发生率比较差异无统计学意义(P>0.05)。结论:髋关节置换术前应用尼可地尔干预可有效改善心脏病患者炎性因子水平,减轻心肌损伤程度,但是否可降低术后MACE风险仍需进一步论证。

Objective To explore the myocardial protective effect of nicorandil preoperative intervention on patients with heart disease undergoing hip replacement surgery.Methods The case data of 117 patients undergoing hip arthroplasty in Rugao Branch Affiliated Hospital of Nantong University from June 2018 to December 2020 were retrospectively analyzed.According to whether nicorandil was given before surgery,they were divided into two groups.The group A and group B was given routine preoperative general anesthesia,and the group B was given nicorandil before surgery.The surgery-related indicators,inflammatory factors,myocardial damage,major adverse cardiac events(MACE)werecompared between the two groups.Results The operation time,intraoperative blood loss,intraoperative fluid rehydration,urine output,Ramsay sedation score on the first day after surgery,visual analogue scale(VAS)score on the first day after surgery,and hospital stay in the two groups had no significant differences(P>0.05).The levels of serum interleukin-6,tumor necrosis factor-α,C-reactive protein,cardiac troponin I,creatine kinase-MB,myoglobin andipoprotein associated phospholipase A2 postoperative in group B were lower than those in the group A:(388.15±56.20)μg/L vs.(456.34±65.18)μg/L,(34.24±8.90)μg/L vs.(40.26±10.22)μg/L,(27.54±5.52)mg/L vs.(30.25±5.61)mg/L,(0.10±0.05)μg/L vs.(0.19±0.08)μg/L,0.059±0.019 vs.0.099±0.026,(68.41±6.03)μg/L vs.(76.61±6.54)μg/L,(201.67±25.88)μg/L vs.(251.37±31.06)μg/L,the differences were statistically significant(P<0.05).There was no statistically significant difference in the total incidence of MACE between the two groups(P>0.05).Conclusions Nicorandil intervention before hip replacement surgery can effectively improve the levels of inflammatory factors in patients with heart disease and reduce the degree of myocardial damage.Whether it can reduce the risk of MACE after surgery still needs to be further demonstrated.