冠状动脉内注射尼可地尔对老年STEMI患者PCI术后即刻心肌血流灌注和预后的影响

发布时间：2018-12-23 19:33

【摘要】：目的探讨预防性冠状动脉内注射尼可地尔对老年急性ST段抬高性心肌梗死(STEMI)患者直接经皮冠脉介入治疗(PCI)术后即刻心肌血流灌注和预后的影响。方法连续入选2013年10月至2015年6月在阜阳市第二人民医院就诊行PCI的老年STEMI患者79例,随机数字法分为尼可地尔组(在引导丝通过靶病变后,冠脉内注射6 mg尼可地尔)26例、硝酸甘油组(冠脉内注射200μg硝酸甘油)26例、常规治疗组(直接置入支架或球囊扩张)27例。采用门控心肌灌注显像测定患者梗死动脉术后即刻心肌血流灌注,通过校正的TIMI帧数(cTFC)反映心肌血流灌注水平。记录患者住院期间不良心血管事件,术后3个月内对三组患者行电话或门诊随访,记录术后药物服用情况和不良心血管事件。结果尼可地尔组c TFC水平明显低于硝酸甘油组和常规治疗组(P0.01);而硝酸甘油组与常规治疗组cTFC水平之间差异无统计学意义(P0.05)。三组间无复流或慢血流比例、2 h内ST段回落比例之间差异均有统计学意义(P0.05);进一步行Logistic回归分析显示,与常规治疗相比,预防性使用尼可地尔是术后发生无复流或慢血流的保护因素,并可促进术后2 h内ST段回落。尼可地尔组患者住院期间再灌注心律失常、术后1 d内心绞痛发生率均明显低于硝酸甘油组和常规治疗组(P0.05);与常规治疗相比,预防性使用尼可地尔是术后再灌注心律失常、术后1 d内心绞痛的保护因素。随访期间三组患者服用的药物差异均无统计学意义(P0.05);尼可地尔组患者梗死后心绞痛、心力衰竭再入院发生率明显低于硝酸甘油组和常规治疗组(P0.05)。结论 PCI术前预防性冠脉内注射6 mg尼可地尔可有效改善老年STEMI患者术后即刻心肌血流灌注水平,降低再灌注心律失常的发生率,同时在改善患者预后方面具有较好效果。
[Abstract]:Objective to investigate the effect of prophylactic intracoronary injection of nicorandil on myocardial perfusion and prognosis in elderly patients with acute ST segment elevation myocardial infarction (STEMI) after direct percutaneous coronary intervention (PCI). Methods from October 2013 to June 2015, 79 elderly STEMI patients who were treated with PCI in Fuyang second people's Hospital were randomly divided into two groups: nicorandil group (26 patients were treated with intracoronary injection of 6 mg nicorandil after guided filaments passing through the target lesion). There were 26 cases in nitroglycerin group (200 渭 g nitroglycerin injected into coronary artery) and 27 cases in routine treatment group (direct stenting or balloon dilatation). Myocardial perfusion was measured by gated myocardial perfusion imaging. Myocardial perfusion was measured by corrected TIMI frame number (cTFC). Adverse cardiovascular events during hospitalization were recorded, and three groups of patients were followed up by telephone or outpatient within 3 months after operation. Drug use and adverse cardiovascular events were recorded. Results the level of c TFC in nicorandil group was significantly lower than that in nitroglycerin group and routine treatment group (P0.01), but there was no significant difference in cTFC level between nitroglycerin group and routine treatment group (P0.05). There was no reflow or slow blood flow ratio between the three groups, and there were significant differences in the ratio of ST segment fall within 2 hours (P0.05). Further Logistic regression analysis showed that prophylactic use of nicorandil was a protective factor for no reflow or slow blood flow after operation compared with routine therapy and could promote the decrease of ST segment within 2 hours after operation. The incidence of angina pectoris in nicordil group was significantly lower than that in nitroglycerin group and routine treatment group (P0.05). Prophylactic use of nicorandil was the protective factor of reperfusion arrhythmia and angina pectoris 1 day after operation compared with routine therapy. During the follow-up period, there was no significant difference in drug use among the three groups (P0.05); the incidence of angina pectoris and heart failure readmission in nicorandil group was significantly lower than that in nitroglycerin group and routine treatment group (P0.05). Conclusion prophylactic intracoronary injection of nicorandil for 6 mg before PCI can effectively improve myocardial perfusion and reduce the incidence of reperfusion arrhythmias in elderly patients with STEMI immediately after operation. It also has a good effect in improving the prognosis of patients with STEMI.
【作者单位】：阜阳市第二人民医院;
【分类号】：R542.22

【相似文献】