静脉硝酸酯对冠状动脉支架术后胸痛和微梗死的影响

Effect of immediate intravenous nitroglycerin on the incidence of postprocedural chest pain and minor myocardial necrosis after coronary stenting

目的 :在冠状动脉支架术后静脉滴注硝酸酯 ,观察其对术后胸痛和微梗死的影响。方法 :以行经皮冠状动脉腔内成形术及支架置入术的心绞痛 (稳定型、不稳定型 )患者 5 6例为入选对象 ,术后随机分为硝酸酯组(A组 ,2 8例 )和非硝酸酯组 (B组 ,2 8例 )。比较两组临床一般特征、冠状动脉病变、置入支架数及术后两组胸痛和微梗死的发生率。结果 :两组在临床一般特征方面、冠状动脉病变、置入支架数差异无显著性意义 (P >0 .0 5 ) ,硝酸酯对术后胸痛的发生率无影响 (A组 2 5 .0 % ,B组 2 8.6 % ,P >0 .0 5 ) ,但可显著减少术后微梗死的发生率 (A组 3.6 % ,B组 2 5 .0 % ,P <0 .0 1)。结论 :选择性支架术后静脉滴注硝酸酯可安全、有效地减少因支架术后并发冠状动脉微栓塞、分支闭塞等引起的微梗死 ,而对术后胸痛的发生无明显影响。

Objective:To investigate the effect of immediate intravenous nitroglycerin on the incidence of postprocedural chest pain and minor myocardial necrosis after coronary stenting.Methods:Fifty six patients with stable or unstable angina were randomly assigned to intravenous nitroglycerin(group A) or placebo(group B) during 12 hours after PTCA with stenting. The baseline characteristics, lesions of coronary artery and interventional variables were compared in 2 groups.Results:Two groups were comparable in respect to baseline characteristics, lesions of coronary artery and interventional variables (P> 0.05 ). The incidence of chest pain was not influenced by nitroglycerin (group A:25%, group B: 28.6 %, P> 0.05 ). However, the occurrence of minor myocardial necrosis was significantly reduced by nitroglycerin(group A: 3.6 %,group B:25%, P< 0.01 ).Conclusion:Routine use of intravenous nitroglycerin after coronary stenting can significantly reduced the occurrence of minor myocardial necrosis due to coronary artery side branch occlusion or coronary microembolism. However, the incidence of postprocedural chest pain remains unchanged.