卡维地洛联合尼可地尔治疗冠状动脉粥样硬化性心脏病心肌缺血的效果分析

Analysis of the Effect of Carvedilol Combined with Nicorandil in the Treatment of Myocardial Ischemia in Coronary Atherosclerotic Heart Disease

目的 探讨冠状动脉粥样硬化性心脏病心肌缺血患者应用卡维地洛与尼可地尔进行联合治疗的效果。方法 方便选择2019年2月—2021年4月邹城市人民医院收治的冠状动脉粥样硬化性心脏病心肌缺血患者102例,按随机数表法分为两组,各51例。对照组行常规治疗,观察组在此基础上加用卡维地洛与尼可地尔,两组均持续治疗12周。对比两组临床疗效、心肌缺血指标、心功能指标及不良反应发生情况。结果 观察组临床总有效率(96.08%)高于对照组(82.35%),差异有统计学意义(χ^(2)=4.993,P=0.025);观察组治疗后心肌缺血总负荷、ST段压低次数、ST段压低持续时间水平分别为(25.22±4.43)mm/min、(2.33±0.45)次/24 h、(17.70±2.93)min,均低于对照组的(41.47±8.60)mm/min、(3.73±0.74)次/24 h、(28.27±4.43)min,差异有统计学意义(t=11.996、11.544、14.212,P<0.001);观察组治疗后室间隔舒张末期厚度(IVSD)、左心室后壁舒张末期厚度(LVPWD)、舒张晚期左房室周前叶峰值流速(A峰)水平分别为(9.02±0.75)mm、(9.24±0.53)mm、(61.49±8.92)cm/s,均低于对照组的(10.62±0.88)mm、(11.55±0.98)mm、(69.63±9.24)cm/s,舒张早期左房室知前叶峰值流速(E峰)、E/A水平分别为(66.67±2.24)cm/s、(1.13±0.24),均高于对照组的(58.59±12.13)cm/s、(0.91±0.22),差异有统计学意义(t=9.882、14.807、4.526、4.678、4.826,P<0.001);观察组不良反应发生率为17.65%,与对照组的11.76%相近,差异无统计学意义(χ^(2)=0.703,P=0.402)。结论 卡维地洛与尼可地尔联合进行冠状动脉粥样硬化性心脏病心肌缺血的治疗,能够获得较好疗效,可有效改善其心肌缺血情况与心功能,且不增加不良反应的发生。

Objective To explore the effect of applying carvedilol in combination with nicorandil for the treatment of myocardial ischemia in patients with coronary atherosclerotic heart disease.Methods 102 patients with myocardial ischemia of coronary atherosclerotic heart disease admitted to Zoucheng People´s Hospital from February 2019 to April 2021 were conveniently selected and divided into two groups of 51 cases each according to the random number table method.The control group was treated conventionally,and the observation group was treated with carvedilol and nicorandil on the basis of this treatment,and both groups were treated for 12 weeks.The clinical efficacy,myocardial ischemic index,cardiac function index and the occurrence of adverse reactions of the two groups were compared.Results The total clinical efficiency of the observation group(96.08%)was higher than that of the control group(82.35%),and the difference was statistically significant(χ^(2)=4.993,P=0.025);the total myocardial ischemic load,number of ST-segment depressions,and duration of ST-segment depression in the observation group after treatment were(25.22±4.43)mm/min,(2.33±0.45)times/24 h,(17.70±2.93)min,which were lower than those of the control group(41.47±8.60)mm/min,(3.73±0.74)times/24 h,(28.27±4.43)min,and the differences were statistically significant(t=11.996,11.544,14.212,P<0.001).The levels of end-diastolic septal thickness(IVSD),end-diastolic left ventricular posterior wall thickness(LVPWD),and late diastolic left atrial peri-anterior leaflet peak flow velocity(Apeak)were(9.02±0.75)mm,(9.24±0.53)mm,and(61.49±8.92)cm/s,respectively,in the observation group after treatment were lower than those in the control group(10.62±0.88)mm,(11.55±0.98)mm,and(69.63±9.24)cm/s,and the peak flow velocity of the left atrial precordial lobe in early diastole(E peak)and E/A level were(66.67±2.24)cm/s,(1.13±0.24),respectively,which were higher than those of the control group(58.59±12.13)cm/s,(0.91±0.22),and the difference was statistically significant(t=9.882,14.807,4.526,4.678,4.826,P<0.001).The incidence of adverse reactions in the observation group was 17.65%,similar to 11.76%in the control group,and the difference was not statistically significant(χ^(2)=0.703,P=0.402).Conclusion The combination of carvedilol and nicorandil for the treatment of myocardial ischemia in coronary atherosclerotic heart disease can achieve better efficacy and effectively improve their myocardial ischemia and cardiac function without increasing the occurrence of adverse reactions.