法舒地尔对冠状动脉介入术中桡动脉痉挛及术后心脏事件的影响

Influence of Fasudil on Radial Artery Spasm in Percutaneous Coronary Intervention and Postoperative Cardiac Events

目的探讨法舒地尔预防冠状动脉介入术(PCI)中桡动脉痉挛及术后心脏事件的作用。方法选择2013年7月至2014年12月医院收治的急性冠脉综合征需行PCI手术的患者90例,随机分为对照组和观察组,各45例。两组患者给予相关对症支持治疗及PCI围手术期常规治疗,对照组患者术中给予硝酸甘油、维拉帕米,观察组患者加用法舒地尔。术后两组患者均给予冠心病二级预防治疗,观察组继续加用法舒地尔,两组均治疗14 d。结果术中,观察组患者桡动脉痉挛(RAS)、局部症状发生率均显著低于对照组(P<0.05)。两组患者心电图异常和全身不良症状发生率相当(P>0.05)。治疗后,两组患者心肌损伤指标、左心室射血分数、血清炎性因子均得到显著改善,且观察组改善幅度明显优于对照组(P<0.05)。治疗后60 d,观察组患者心脏不良事件发生率为8.88%,显著低于对照组的17.77%(P<0.05)。两组患者不良反应均较轻,发生率差异无统计学意义(P>0.05)。结论法舒地尔可预防冠状动脉介入术中RAS,维持心电图正常,减少术中全身及局部不良症状,改善术后心肌功能,降低炎性因子表达,减少术后心脏事件的发生,且无明显不良反应发生,值得临床推广。

Objective To investigate the influence of fasudil on preventing radial artery spasm in percutaneous coronary intervention and the postoperative cardiac events. Methods 90 cases of patients with acute coronary syndrome for PCI surgery from July 2013 to December 2014 admitted to the hospital were randomly divided into the control group and the observation group,45 cases in each group. The two groups were given symptomatic and supportive treatment and PCI- related conventional perioperative treatment,the control group was given nitroglycerin and verapamil; the observation group was added with fasudil. During the postoperative period,all patients were given treatment for secondary prevention of coronary heart disease,and based on this,the observation group continued to use fasudil. The two groups were treated for 14 d. Results During the intervention,the incidence of RAS,the local reaction rate and the total incidencerate of adverse events of the observation group were significantly lower than those of the control group( P < 0. 05); after treatment,the indicators of myocardial injury in patients with left ventricular ejection fraction,serum inflammatory factors were significantly improved compared with before treatment( P < 0. 05),and the improvement in the observation group was better than the control group( P < 0. 05). 60 d after treatment,the incidence rate of total cardiac events in the observation group was 8. 88%,which was significantly lower than 17. 77% of the control group( P < 0. 05). The adverse reactions in the two group were mild,and the difference was not statistically significant( P > 0 05.). Conclusion Fasudil can prevent radial artery spasm in coronary intervention and the postoperative cardiac events,maintain a normal electrocardiogram,reduce the adverse syndromes during and after operation,improve the postoperative cardiac functions,decrease the postoperative cardiac events with no obvious adverse reactions,which is worthy of clinical promotion.