STEMI患者PCI术前预注射尼可地尔对无复流的预防作用

杨汆; 胡文志; 王迪斌; 汪喆; 杜新丽; 谭晓

doi:10.13201/j.issn.1001-1439.2019.04.011

STEMI患者PCI术前预注射尼可地尔对无复流的预防作用

- 南京医科大学第二附属医院急诊科(南京, 210008)
基金项目:
南京医科大学科技发展基金重点项目（No：2013NJMU052）

详细信息

通讯作者: 谭晓,E-mail:xiao0330@sina.com

中图分类号: R542.2

收稿日期: 2018-11-22

Effect of nicorandil on no-reflow before PCI in STEMI

- Department of Emergency, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210008, China

More Information

Corresponding author: TAN Xiao, E-mail: xiao0330@sina.com

Received Date: 22 November 2018

摘要

摘要: 目的：探究冠状动脉（冠脉）靶血管内预先注射尼可地尔对行经皮冠脉介入治疗（PCI）术的急性ST段抬高型心肌梗死（STEMI）患者术中无复流现象（NRP）的预防效果及对心肌损伤、心功能的影响。方法：选择2016-03-2018-04我院收治的需行急诊PCI术的STEMI患者135例，采用随机数字表法将其分为A组、B组和C组，每组各45例。A组给予0.9%氯化钠溶液治疗，B组给予硝普钠治疗，C组给予尼可地尔治疗，均经冠脉靶血管内预先注射药物后行PCI术。比较3组手术前后TIMI血流分级、PCI术中NRP发生率、心肌损伤指标及心功能水平，并比较3组术后低血压及主要心脏不良事件发生率。结果：术后，3组TIMI血流分级及NRP发生率比较均有明显差异（P<0.05）；术后7 d，3组血清N末端脑钠肽前体（NT-proBNP）水平比较有明显差异（P<0.05），且B组、C组血清NT-proBNP水平均明显低于A组（P<0.05）。术后，3组血清肌酸激酶同工酶-MB （CK-MB）及肌钙蛋白（cTnI）峰值水平比较均有明显差异（P<0.05），且B组、C组血清CK-MB、cTnI水平均明显低于A组（P<0.05）；术后7 d，3组室壁运动积分指数（WMSI）及左心室射血分数（LVEF）比较均有明显差异（P<0.05），且B组、C组LVEF均明显高于A组（P<0.05），B组、C组WMSI均明显低于A组（P<0.05）；术后，3组低血压及主要心脏不良事件发生率比较均有明显差异（P<0.05）。结论：冠脉靶血管内预先注射尼可地尔，可有效预防行PCI术的STEMI患者术中NRP的发生，其具有减轻心肌损伤、改善心功能的作用，且术后患者低血压及不良事件的发生率较低。
- 尼可地尔 /
- 经皮冠状动脉介入治疗 /
- 无复流现象 /
- 心肌损伤 /
- 心功能
Abstract: Objective: To explore the effect of target intracoronary injection of nicorandil for the prevention of no-reflow phenomenon (NRP) during emergency percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) and its effect on myocardial injury and cardiac function.Method: A total of 135 patients with STEMI who were admitted to our hospital for emergency PCI were selected from Mar.2016 to Apr.2018, and they were randomly divided into group A, group B and group C with 45 cases in each group.Group A was treated with 0.9% sodium chloride solution, group B was treated with sodium nitroprusside, and group C was treated with nicorandil, PCI was performed after target intracoronary injection of drugs.The TIMI blood flow grade, the incidence of NRP in PCI, the level of myocardial injury index and the level of cardiac function were collected, and the incidence of postoperative hypotension and major adverse cardiac events were compared.Result: After operation, there were significant differences in TIMI blood flow grade and the incidence of NRP among the 3 groups (P<0.05);At 7 days after operation, there were significant differences in the level of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) among the 3 groups (P<0.05), and the level of serum NT-proBNP in group B and group C were significantly lower than that of group A (P<0.05).The peak levels of serum creatine kinase MB (CK-MB) and cardiac troponin I (cTnI) were significantly different among the three groups (P<0.05), and the levels of serum CK-MB and cTnI in group B and C were significantly lower than those in group A (P<0.05).At 7 days after operation, there were significant differences in the wall motion score index (WMSI) and left ventricular ejection fraction (LVEF) among the three groups (P<0.05), and the LVEF in group B and group C was significantly higher than that in group A (P<0.05), the WMSI in group B and group C was significantly lower than that in group A (P<0.05).After operation, there were significant differences in the incidence of hypotension and major adverse cardiac events among the 3 groups (P<0.05).Conclusion: Target intracoronary injection of nicorandil can effectively prevent the occurrence of NRP in patients with acute STEMI undergoing PCI, which can alleviate myocardial injury and improve cardiac function.The incidence of hypotension and adverse events after operation is low.
- nicorandil /
- percutaneous coronary intervention /
- no-reflow phenomenon /
- myocardial injury /
- cardiac function

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