围手术期应用尼可地尔与硝酸甘油对急性心肌梗死介入手术患者心肌的保护效应探讨

The myocardial protective effects of nicorandil and nitroglycerin in perioperative patients with acute myocardial infarction undergoing interventional surgery

目的 观察围手术期应用尼可地尔与硝酸甘油对急性心肌梗死介入手术患者心肌的保护效应。方法 60例急性心肌梗死介入手术患者,依据围手术期治疗药物不同分为研究组和对照组,各30例。研究组患者围手术期静脉应用尼可地尔治疗,对照组患者围手术期静脉应用硝酸甘油治疗。比较两组患者治疗前后生化指标[肌酸激酶同工酶(CK-MB)、超敏心肌肌钙蛋白T(hs-cTnT)]、心功能指标[左室射血分数(LVEF)、心排血量(CO)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)]、6 min步行距离(6MWD)及围手术期心血管不良事件发生情况、药物不良反应发生情况。结果 治疗前及治疗后6、12、24 h,研究组CK-MB水平分别为(305.43±41.35)、(234.45±43.52)、(142.37±36.41)、(82.52±21.17)ng/ml,hs-cTnT水平分别为(283.17±40.46)、(101.98±13.22)、(71.47±16.31)、(40.69±12.18)ng/ml;对照组CK-MB水平分别为(303.38±39.46)、(256.43±34.37)、(174.85±42.26)、(104.36±31.25)ng/ml,hs-cTnT水平分别为(280.23±42.32)、(135.53±14.27)、(102.05±21.46)、(71.05±19.29)ng/ml。治疗前,两组CK-MB和hs-cTnT水平比较差异无统计学意义(P>0.05);治疗后6、12、24 h,两组CK-MB和hs-cTnT水平均显著低于治疗前,且研究组低于对照组,差异有统计学意义(P<0.05)。治疗前,两组LVEF、CO、LVESD、LVEDD及6MWD比较差异无统计学意义(P>0.05);治疗后3 d,两组LVEF、CO、LVESD、LVEDD及6MWD均优于治疗前,且研究组LVEF(61.68±8.25)%、CO(5.88±1.22)L/min、LVESD(32.72±3.51)mm、LVEDD(52.47±5.36)mm及6MWD(245.88±30.22)m均优于对照组的(50.23±6.87)%、(4.14±1.37)L/min、(40.45±4.96)mm、(57.99±5.58)mm、(196.61±21.63)m,差异有统计学意义(P<0.05)。研究组围手术期心血管不良事件发生率与药物不良反应发生率与对照组比较,差异无统计学意义(P>0.05)。结论 对急性心肌梗死介入手术患者围手术期应用尼可地尔可显著降低术后CK-MB、hs-cTnT水平,改善心功能,增加6MWD,对于心肌保护效应理想。

Objective To observe the myocardial protective effects of nicorandil and nitroglycerin in perioperative patients with acute myocardial infarction undergoing interventional therapy.Methods A total of 60 patients with acute myocardial infarction undergoing interventional surgery were divided into research group and control group according to different drugs used in perioperative period.Patients in the research group were treated with intravenous nicorandil,while patients in the control group were treated with intravenous nitroglycerin during perioperative period.Both groups were compared in terms of biochemical indexes[creatine kinase isoenzyme(CK-MB),high-sensitivity cardiac troponin T(hs-cTnT)],cardiac function indexes[left ventricular ejection fraction(LVEF),cardiac output(CO),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD)]and 6 min walking test(6MWD)distance before and after treatment,occurrence of perioperative cardiovascular adverse events,and adverse drug reactions.Results Before and 6,12 and 24 h after treatment,in the research group,CK-MB levels were(305.43±41.35),(234.45±43.52),(142.37±36.41)and(82.52±21.17)ng/ml,and hs-cTnT levels were(283.17±40.46),(101.98±13.22),(71.47±16.31)and(40.69±12.18)ng/ml;in the control group,CK-MB levels were(303.38±39.46),(256.43±34.37),(174.85±42.26)and(104.36±31.25)ng/ml,and hs-cTnT levels were(280.23±42.32),(135.53±14.27),(102.05±21.46)and(71.05±19.29)ng/ml.Before treatment,there was no statistically significant difference in CK-MB and hs-cTnT levels between the two groups(P>0.05).At 6,12 and 24 h after treatment,the levels of CK-MB and hs-cTnT in both groups were significantly lower than those before treatment in this group;the research group was lower than the control group;the differences were statistically significant(P<0.05).Before treatment,the differences in LVEF,CO,LVESD,LVEDD and 6MWD distance between the two groups were not statistically significant(P>0.05).After 3 d after treatment,LVEF,CO,LVESD,LVEDD and 6MWD distance in both groups were better than those before treatment in this group;the research group had LVEF of(61.68±8.25)%,CO of(5.88±1.22)L/min,LVESD of(32.72±3.51)mm,LVEDD of(52.47±5.36)mm and 6MWD distance of(245.88±30.22)m,which were better than those of(50.23±6.87)%,(4.14±1.37)L/min,(40.45±4.96)mm,(57.99±5.58)mm,and(196.61±21.63)m in the control group;the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of perioperative cardiovascular adverse events and the incidence of adverse drug reactions between the research group and the control group(P>0.05).Conclusion In perioperative patients with acute myocardial infarction undergoing interventional surgery,nicorandil can significantly reduce the levels of CK-MB and hs-cTnT,improve cardiac function,and increase the 6MWD distance,which is ideal for myocardial protection.