尼可地尔联合琥珀酸美托洛尔缓释片对急性心肌梗死患者恢复期冠状动脉微循环和心肌重塑的影响

Effects of nicorandil combined with metoprolol succinate sustained-release tablets on coronary microcirculation and myocardial remodeling in patients with acute myocardial infarction in the recovery period

目的观察尼可地尔联合琥珀酸美托洛尔缓释片对急性心肌梗死(AMI)患者恢复期冠状动脉微循环和心肌重塑的影响。方法选取2018年10月至2023年10月蒲县人民医院收治的AMI患者122例,按治疗方法分成对照组与试验组,各61例,对照组采用琥珀酸美托洛尔缓释片治疗,试验组在对照组基础上增加尼可地尔治疗,比较2组患者恢复期冠状动脉微循环指标、心肌重塑与心功能指标、炎症因子水平、心血管不良事件与药物不良反应发生情况。结果治疗后,试验组冠状动脉微循环阻力指数(IMR)为(23±4)U,低于对照组(28±4)U,冠状动脉血流储备(CFR)为(2.97±0.36),高于对照组(2.03±0.31)(P<0.05)。治疗后,试验组左心室射血分数(LVEF)[(42.2±3.4)%]高于对照组[(37.4±3.2)%],试验组左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)分别为[(45±4)mm、(53±4)mm],低于对照组[(42±5)mm、(49±5)mm](P<0.05)。治疗后试验组C反应蛋白(CRP)、肿瘤坏死因子(TNF-α)、白细胞介素(IL)-6水平分别为[(3.7±1.2)ng/L、(7.2±1.4)ng/L、(8.0±2.0)ng/L],较对照组[(5.6±1.3)ng/L、(11.2±1.5)ng/L、(11.2±2.4)ng/L]更低(P<0.05)。试验组(9.8%)心血管不良事件发生率低于对照组(21.3%)(P<0.05)。试验组与对照组不良反应发生率分别为18.0%、13.1%,差异无统计学意义(P>0.05)。结论尼可地尔与琥珀酸美托洛尔缓释片联合治疗AMI恢复期患者能有效改善其冠状动脉微循环、逆转心肌重塑、调节炎症反应并降低心血管不良事件发生风险,同时用药安全性较高。

ObjectiveTo observe the effects of nicorandil combined with metoprolol succinate sustained-release tablets on coronary microcirculation and myocardial remodeling in patients with acute myocardial infarction(AMI)in the recovery period.MethodsA total of 122 AMI patients admitted from October 2018 to October 2023 in Puxian People′s Hospital were selected and divided into a control group and an experimental group,with 61 cases in each group by different treatment methods.The control group was treated with metoprolol succinate sustained-release tablets,while the experimental group received additional nicorandil treatment on the basis of the same treatment as the control group.The recovery period coronary microcirculation indicators,myocardial remodeling and cardiac function indicators,inflammatory factor levels,cardiovascular adverse events,and drug adverse reactions were compared between two groups of patients.The recovery period coronary microcirculation indicators,myocardial remodeling and cardiac function indicators,inflammatory factor levels,cardiovascular adverse events,and drug adverse reactions were compared between the two groups.ResultsAfter treatment,the index of microcirculatory resistance(IMR)in the experimental group was(23±4)U,which was lower than that in the control group(28±4)U,and the coronary blood flow reserve(CFR)was(2.97±0.36),which was higher than that in the con-trol group(2.03±0.31)(P<0.05).After treatment,the left ventricular ejection fraction(LVEF)of the experimental group[(42.2±3.4)%]was significantly higher than that of the control group[(37.4±3.2)%],and the left ventricular end-diastolic internal diameters(LVEDd)and the left ventricular end-systolic internal diameters(LVESd)of the experimental group were[(45±4)mm,(53±4)mm],respectively,significantly lower than that of the control group[(42±5)mm,(49±5)mm](P<0.05).The levels of CRP,TNF-αand IL-6 in the experimental group were[(3.7±1.2)ng/L,(7.2±1.4)ng/L,and(8.0±2.0)ng/L,which were significantly lower than those in the control group[(5.6±1.3)ng/L,(11.2±1.5)ng/L,(11.2±2.4)ng/L](P<0.05).The incidence of adverse cardiovascular events in the experimental group(9.8%)was lower than that in the control group(21.3%)(P<0.05).The incidence of adverse reactions in the experimental group and the control group was 18.0%and 13.1%,respectively,and the difference was not significant(P>0.05).ConclusionNicorandil combined with metoprolol succinate sustained-release tablets can effectively improve coronary microcirculation,reverse myocardial remodeling,regulate inflammatory response,and reduce the risk of adverse cardiovascular events in patients with AMI in the recovery period.In addition,the medication regimen is relatively safe.