冠状动脉靶血管内注射尼可地尔对急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗术中无复流现象的预防效果研究

发布时间：2018-03-28 02:09

  本文选题：心肌梗死　切入点：血管成形术　出处：《中国全科医学》2017年23期

【摘要】：目的观察无复流现象(NRP)发生前冠状动脉靶血管内注射尼可地尔对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术中NRP的预防效果。方法选择2015年1月—2016年9月河北医科大学第三医院收治的需行急诊PCI术的急性STEMI患者105例,采用随机数字表法分为尼可地尔组、硝普钠组和对照组,每组各35例。尼可地尔组采用球囊扩张及加压泵于靶血管向靶病变远端2 mm处预先注射尼可地尔2 mg、硝普钠组注射硝普钠200μg、对照组注射0.9%氯化钠溶液。观察PCI术前及结束时梗死相关血管心肌梗死溶栓试验(TIMI)血流分级、校正TIMI血流帧数(c TFC)、TIMI心肌灌注分级(TMPG)、术中NRP发生率及术后90 min ST段回落率(STR),PCI术前及术后1周时检测N末端脑钠肽前体(NT-pro BNP);PCI术前及术后每4 h检测肌酸激酶同工酶(CK-MB)及肌钙蛋白I(c Tn I),记录其峰值水平。PCI术前及术后1周时采用心脏彩超计算室壁运动积分指数(WMSI)及左心室射血分数(LVEF)。观察PCI术中低血压发生情况及术后预后情况。结果 3组患者术前TIMI血流分级、达到TMPG 3级的比例、NT-pro BNP、CK-MB、c Tn I、WMSI及LVEF比较,差异均无统计学意义(P0.05)。硝普钠组和尼可地尔组患者术后c TFC及NRP发生率较对照组降低,术后达到TMPG 3级的比例及STR≥50%的比例较对照组升高(P0.05);硝普钠组和尼可地尔组患者术后NT-pro BNP、CK-MB峰值、c Tn I峰值、WMSI较对照组降低,术后LVEF较对照组升高(P0.05)。硝普钠组与尼可地尔组患者c TFC、术后达到TMPG 3级的比例、NRP发生率、STR≥50%的比例、术后NT-pro BNP、CK-MB峰值、c Tn I峰值、WMSI及LVEF比较,差异均无统计学意义(P0.05)。对照组、硝普钠组及尼可地尔组术中分别有3例(9.1%)、8例(24.2%)及0例发生低血压,需多巴胺处理,3组低血压发生率比较,差异有统计学意义(χ2=10.236,P=0.006);其中硝普钠组低血压发生率较尼可地尔组升高(P0.01)。3组PCI术后3个月主要心脏不良事件(MACEs)发生率分别为:15.2%(5/33)、6.1%(2/33)及5.9%(2/34),差异无统计学意义(χ2=2.276,P=0.320)。结论 NRP发生前冠状动脉靶血管内注射尼可地尔可安全、有效地预防急性STEMI患者急诊PCI术中NRP发生,并改善心肌灌注水平和心功能。
[Abstract]:Objective to observe the preventive effect of intracoronary intravascular injection of nicorandil on NRP during emergency percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction (STEMI) before reflow. From January to September 2016, 105 patients with acute STEMI who needed emergency PCI operation were admitted to the third Hospital of Hebei Medical University. The patients were randomly divided into three groups: nicorandil group, sodium nitroprusside group and control group. In each group, 35 cases were treated by balloon dilatation and pressure-pump injection of nicorandil 2 mg at 2 mm to the distal end of the target, sodium nitroprusside 200 渭 g and control group 0.9% sodium chloride solution. PCI was observed. Thrombolytic test (TIMIT) was performed before and at the end of infarct related vessel myocardial infarction. Adjusted TIMI blood flow frame count and myocardial perfusion grade of TIMI, the incidence of NRP during operation and the rate of St segment fall after 90 min were measured before and 1 week after PCI to detect the isoenzyme of creatine kinase before and every 4 hours after PCI. The peak level of CK-MBand cardiac troponin C Tn I were recorded. The ventricular wall motion score (WMSI) and left ventricular ejection fraction (LVEF) were calculated by color Doppler echocardiography before and 1 week after PCI. The incidence of hypotension and postoperative prognosis in PCI were observed. Results TIMI blood flow grading was performed in 3 groups before operation. There was no significant difference in NT-pro BNPCK-MBC TMPG and LVEF. The incidence of c TFC and NRP in sodium nitroprusside group and nicorandil group was lower than that in control group. The proportion of patients with TMPG grade 3 and STR 鈮，

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