经改良球囊导管冠脉内注射尼可地尔对急性ST段抬高型心肌梗死患者心肌组织灌注及预后的影响

Effect of intracoronary injection of nicorandil via modified balloon catheter on myocardial perfusion and prognosis in patients with acute ST-segment elevation myocardial infarction

目的探讨经改良球囊导管冠脉内注射尼可地尔与急性ST段抬高型心肌梗死(STEMI)患者心肌组织灌注及预后的影响的关系。方法选择STEMI接受急诊PCI的患者235例,经指引导管给药为对照组(A组,n=105)和经改良球囊导管给药为实验组(B组,n=130)。观察心肌组织灌注及1年主要心脏不良事件(MACE)发生情况。根据主要心脏不良事件(MACE)的发生,分为MACE(+)组和MACE(-)组,对2组数据进行分析,相关性采用Logistic回归分析。结果校正的TIMI血流计数帧数(CTFC)B组低于A组(P<0.05),ST段回落(STR>50%)发生率B组高于A组(P<0.05)。2组间MACE事件发生率差异均无统计学意义(P>0.05)。MACE(+)组中射血分数明显低于MACE(-)组(P<0.05),CTFC、STR(>50%)和给药方式差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,心脏不良事件的危险因素与白细胞计数(P<0.05,OR=1.77)、射血分数(P<0.05,OR=0.65)有相关性。结论经改良球囊导管冠脉内注射尼可地尔可以带来STEMI患者STR和CTFC的改善,但与1年MACE的发生无关。

Objective To investigate the relationship between intracoronary injection of nicorandil and myocardial tissue perfusion and prognosis in patients with acute ST-segment elevation myocardial infarction.Methods 235 patients with STEMI were divided into two groups according to their drug-delivery way.The patients were followed up for one year.Clincial data,major adverse cardiac events(MACE)were analyzed,and the correlation was analyzed by Logistic regression.Results The CTFC in group B was lower than that in group A(P<0.05),STR(>50%)in group B was higher than that in group A(P<0.05).There was no significant difference in the incidence of MACE events between the two groups(P>0.05).The ejection fraction in the MACE(+)group was significantly lower than that in the MACE(-)group(P<0.05),and the CTFC,STR(>50%)and the mode of administration were not significant difference(P>0.05).Multivariate logistic regression analysis showed drug-delivery ways(P>0.05,OR=1.29),and white blood cell count(P<0.05,OR=1.77),ejection fraction(P<0.05,OR=0.65).Conclusion Intracoronary injection of nicorandil in modified balloon catheter can improve STR and CTFC in STEMI patients,but it is not associated with one-year MACE.