Effect of percutaneous coronary intervention combined with nicorandil on the coronary microcirculation and ultrasound signs
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摘要: 目的 分析经皮冠状动脉介入(PCI)结合尼可地尔对冠状动脉(冠脉)微循环及超声征象的影响。 方法 纳入我院2022年4月—2023年4月行PCI治疗的患者67例，随机分为研究组(34例)与对照组(33例)，分别采用PCI联合尼可地尔治疗与PCI常规治疗。比较两组间冠脉微循环阻力指数(MRI)、冠脉血流储备指数(CFR)、超声影像指标、冠脉血流灌注情况以及凝血功能指标[凝血酶原时间(PT)、纤维蛋白原(FBG)、血小板聚集率(PAgT)]的差异。 结果 研究组与对照组组间PCI时间差异无统计学意义。治疗前两组间MRI、CFR、二尖瓣环舒张晚期运动速度(Am)、二尖瓣舒张早期血流速度峰值(E)、E/A、PT、FBG及PagT均差异无统计学意义；治疗3个月后，研究组MRI、校正TIMI血流帧数(CTFC)、肌酸激酶同工酶(CK-MB)峰值、再灌注心律失常患者比例、PT、FBG、PAgT均低于对照组，CFR、Am、E、E/A、CK-MB达峰值时间 < 14 h患者比例高于对照组(均P＜0.05)。 结论 PCI结合尼可地尔能更好地改善患者冠脉微循环，提升心肌灌注功能，改善凝血功能，临床综合应用价值更高。Abstract: Objective To analyze the effect of percutaneous coronary intervention (PCI) combined with nicorandil on coronary microcirculation and ultrasonic signs. Methods A total of 67 patients who underwent PCI in our hospital from April 2022 to April 2023 were randomly divided into the study group (n=34) and the control group (n=33). Patients in the study group received PCI combined with nicorandil treatment, while those in the control group received PCI conventional treatment. The coronary microcirculation resistance index (MRI), coronary flow reserve index (CFR), ultrasound imaging indicators, coronary blood flow perfusion, and coagulation function indicators [prothrombin time (PT), fibrinogen (FBG), platelet aggregation rate (PAgT)] between the two groups were compared. Results There was no statistically significant difference in PCI time between the study group and the control group. There were no statistically significant differences in MRI, CFR, speed of movement in late mitral annular relaxation (Am), peak blood flow velocity during early mitral valve relaxation (E), E/A, PT, FBG, and PagT between the two groups before treatment. After 3 months of treatment, compared to the control group, the study group had lower MRI, corrected TIMI frame count (CTFC), peak creatine kinase isoenzyme (CK-MB), proportion of patients with reperfusion arrhythmia, PT, FBG, and PagT, simultaneously had higher CFR, Am, E, E/A, and proportion of patients with CK-MB peak time < 14 hours (all P < 0.05). Conclusion PCI combined with nicorandil can better improve coronary microcirculation, increase myocardial perfusion function, and improve coagulation function. Its comprehensive application value is higher.
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Key words:
- percutaneous coronary intervention /
- nicorandil /
- microcirculation /
- ultrasound
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表 1 患者基线资料
Table 1. Baseline data
例(%), X±S 项目 对照组(33例) 研究组(34例) χ2/t P 年龄/岁 63.89±8.24 64.67±7.67 0.329 0.771 男性 18(54.55) 19(55.88) 0.012 0.912 病程/年 3.94±1.08 3.63±1.31 0.141 0.921 疾病类型 0.012 0.912 心律失常 10(30.30) 11(32.35) 冠脉粥样硬化 14(42.42) 14(41.18) STEMI 4(12.12) 4(11.76) 其他 5(15.15) 5(14.71) 高血压病史 29(87.88) 27(79.41) 0.875 0.350 吸烟史 20(60.61) 21(61.76) 0.010 0.922 STEMI：ST段抬高型心肌梗死。 
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表 2 治疗前后冠脉微循环指标比较
Table 2. The comparison of coronary microcirculatory indexes before and after treatment
X±S 组别 MRI CFR 治疗前 治疗后 治疗前 治疗后 对照组(33例) 31.8±4.17 27.71±3.851) 1.31±0.25 1.86±0.291) 研究组(34例) 31.53±4.35 24.58±4.041)2) 1.22±0.28 2.78±0.331)2) 与同组治疗前比较，1)P＜0.05；2)与对照组治疗后比较，2)P＜0.05。
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表 3 治疗前后超声影像指标比较
Table 3. The comparison of ultrasound indexes before and after treatment
X±S 组别 Am/(cm/s) E/(cm/s) E/A 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组(33例) 7.60±1.62 9.28±1.431) 62.46±6.38 69.61±5.121) 0.77±0.10 0.85±0.061) 研究组(34例) 7.43±1.54 10.62±1.931)2) 62.92±6.51 73.14±4.691)2) 0.70±0.14 1.12±0.111)2) 与同组治疗前比较，1)P＜0.05；2)与对照组治疗后比较，2)P＜0.05。
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表 4 治疗后冠脉血流灌注情况比较
Table 4. The comparison of coronary blood perfusion after treatment
例(%), X±S 组别 CTFC/帧 再灌注心律失常 CK-MB达峰时间＜14 h CK-MB峰值/(U/L) 对照组(33例) 29.63±5.05 9(27.27) 25(75.76) 249.63±96.63 研究组(34例) 25.31±4.371) 3(8.82)1) 33(97.06)1) 196.63±95.631) 与对照组比较，1)P＜0.05。
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表 5 治疗前后凝血指标比较
Table 5. The comparison of coagulation function indicators before and after treatment
X±S 组别 PT/s FBG/(cm/s) PAgT/% 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组(33例) 11.06±2.01 15.63±2.371) 3.88±1.11 4.79±1.021) 51.37±11.07 37.56±6.911) 研究组(34例) 11.08±1.93 12.63±2.211)2) 3.88±1.14 4.02±0.981)2) 51.42±11.67 29.63±7.311)2) 与同组治疗前比较，1)P＜0.05；与对照组治疗后比较，2)P＜0.05。
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