尼可地尔对冠状动脉慢血流即刻效应的临床研究

发布时间：2018-04-04 00:06

本文选题：慢血流　切入点：尼可地尔　出处：《河北医科大学》2017年硕士论文

【摘要】：目的:冠状动脉慢血流现象(coronary slow flow phenomenon,CSFP)是一种特殊的冠状动脉微血管疾病,其发生机制不明确,治疗方法有限。本研究采用冠状动脉内注射尼可地尔(nicorandil)的方法,通过注射前及注射后1、3、5、10分钟造影剂充盈血管末端帧数的变化,观察尼可地尔对CSFP的即时效果。方法:选取2014年10月至2016年12月因胸痛在河北医科大学第三医院心血管一科行冠状动脉造影(coronary angiography,CAG)证实心外膜主要冠状动脉无狭窄病变、存在CSFP的患者56例。冠状动脉血流缓慢定义为造影剂在3个心动周期内不能到达血管末端。根据住院号尾数将患者随机分为2组,住院号尾数为偶数列为试验组,奇数列为对照组。试验组共36例,经冠状动脉造影导管向冠状动脉内注射尼可地尔2mg(4mg/min),以TIMI帧计数(TFC)法定量评价冠状动脉血流,记录给药前及给药后1min、3min、5min、10min时冠状动脉内TFC值;对照组共20例,经冠状动脉造影导管向冠状动脉内注射硝酸甘油200μg(400μg/min),同上方法观察TFC值变化,同时记录给药前后试验组和对照组的心率,收缩压和舒张压。结果:1基本资料:两组患者临床基本特征相似,差异无统计学意义,参见表1。2两组用药前后TFC值变化:试验组中LAD、RCA及LCX内应用尼可地尔后1分钟TFC值最低,1分钟时TFC值与给药前、给药后3分钟、5分钟、10分钟比较均有显著性差异(P0.001)。对照组LAD内应用硝酸甘油后1分钟TFC值最低,1分钟TFC值与给药前、给药后3分钟、5分钟、10分钟比较均有显著性差异(P0.001)。对照组LCX、RCA内应用硝酸甘油后1分钟时TFC值最低,但1分钟时TFC值与给药前、给药后3、5、10分钟比较差异无统计学意义(P0.05)。试验组和对照组在给药1分钟时TFC变化最明显,通过比较两组在1分钟时TFC的减少百分比,对比两种药物效果。试验组LAD、LCX内TFC减少百分比大于对照组,且有显著性差异(P0.05);试验组RCA内TFC值减少百分比与对照组比较差异无统计学意义(P0.05)。3两组用药前后心率及血压变化:试验组冠状动脉内注射尼可地尔前及用药后1、3、5、10分钟,心率无明显变化;对照组冠状动脉内注射硝酸甘油前及用药后1、3、5、10分钟心率比较,1分钟时心率最高;试验组和对照组冠状动脉内注射药物前及用药后1、3、5、10分钟,收缩压、舒张压在1分钟时最低。结论:1冠状动脉内注射尼可地尔和硝酸甘油均可改善CSFP中的TFC。2冠状动脉内注射尼可地尔在CSFP中降低TFC的即刻效应优于硝酸甘油。3冠状动脉内注射尼可地尔在给药后1min作用最明显,5分钟后TFC恢复到用药前水平,作用时间短暂。
[Abstract]:Objective: coronary slow flow (CSFP) is a special coronary microvascular disease with unclear mechanism and limited treatment.In this study, intracoronary injection of nicoranil was used to observe the immediate effect of nicorandil on CSFP.Methods: from October 2014 to December 2016, 56 patients with CSFP were selected from the Department of Cardiovascular and Cardiovascular Department of the third Hospital of Hebei Medical University, from October 2014 to December 2016, to confirm that there was no stenosis in the main epicardial coronary artery.Slow coronary flow is defined as a contrast agent that fails to reach the end of the vessel during three cardiac cycles.Patients were randomly divided into two groups according to the Mantissa of the hospitalization number. The Mantissa of the hospitalization number was even as the experimental group and the odd number as the control group.A total of 36 patients in the trial group were treated with intracoronary injection of nicorandil (2mg / min) into the coronary artery via coronary angiography catheter. Coronary blood flow was evaluated by TIMI frame counting (TIMI frame count) method, and the coronary TFC values were recorded before and 1 min after administration of the drug, and 20 cases in the control group.Nitroglycerin 200 渭 g / min was injected into the coronary artery via coronary angiography catheter. The changes of TFC were observed. Heart rate, systolic blood pressure and diastolic blood pressure were recorded before and after administration of the drug.Results: the clinical characteristics of the two groups were similar, but the difference was not statistically significant.See Table 1.2 changes of TFC values before and after administration in two groups: there were significant differences in TFC values between the two groups before and after administration of LADX RCA and LCX at the lowest TFC value in 1 minute and before administration and at 3 minutes and 5 minutes and 10 minutes after administration respectively (P 0.001).In the control group, the lowest TFC value was 1 minute after the application of nitroglycerin and the lowest one minute TFC value in the control group. There were significant differences between the control group and the control group before administration of nitroglycerin and 3 minutes and 5 minutes and 10 minutes after administration of nitroglycerin (P 0.001).In the control group, the TFC value was the lowest at 1 minute after nitroglycerin administration, but there was no significant difference between the TFC value at 1 minute and that before and after 3 minutes of administration for 10 minutes (P 0.05).The changes of TFC were most obvious in the experimental group and the control group at 1 minute. The effect of the two drugs was compared by comparing the percentage of decrease of TFC in the two groups at 1 minute.The percentage of TFC reduction in LADL-LCX in the trial group was higher than that in the control group.There was no significant difference in the percentage of TFC reduction in RCA between the two groups before and after administration of P0.053.The changes of heart rate and blood pressure in the two groups were as follows: before and after intracoronary injection of nicorandil in the trial group, the changes of heart rate and blood pressure were 10 minutes before and after intracoronary injection of nicordil, and there was no significant difference in the percentage of TFC in the trial group compared with the control group.There was no significant change in heart rate, the heart rate was the highest in the control group before and after the injection of nitroglycerin in the coronary artery, and the systolic blood pressure in the experimental group and the control group was 510 minutes before and after the intracoronary injection of nitroglycerin, and the heart rate in the control group was higher than that in the control group before and after the injection of nitroglycerin.Diastolic blood pressure is lowest in 1 minute.Conclusion both intracoronary nicorandil and nitroglycerin can improve the immediate effect of intracoronary nicorandil injection in CSFP on reducing TFC in CSFP, which is better than that of nitroglycerin 3 intracoronary injection of nicorandil in CSFP.The effect of 1min was the most obvious after 5 minutes. The level of TFC returned to the pre-medication level.The action time is short.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R543.3

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