尼可地尔对缺血性心肌病患者心功能的影响

目的: 探讨尼可地尔对缺血性心肌病患者心功能的影响。方法: 选取缺血性心肌病未接受血管重建患者72例, 随机分为观察组和对照组, 各36例。所有患者均给予阿司匹林、利尿剂、洋地黄类、血管紧张素转换酶抑制剂、硫酸氢氯吡格雷、醛固酮拮抗剂、硝酸酯类、β受体阻滞剂等常规治疗, 观察组在常规治疗基础上给予尼可地尔。2组患者均于治疗前和治疗后6个月查B型利钠肽、6 min步行试验距离及超声心动图;观察住院期间和出院后6个月随访主要心脏不良事件。结果: 观察组总有效率97.2%, 对照组为80.6%, 2组治疗效果差异无统计学意义(P>0.05);治疗后观察组左心室舒张末期容积、左心室收缩末期容积、二尖瓣舒张早期血流速度峰值/二尖瓣舒张晚期血流速度峰值改善情况均优于对照组(P<0.05～P<0.01), 2组左心室射血分数改善情况差异无统计学意义(P>0.05);2组6 min步行试验距离、B型利钠肽均较治疗前改善(P<0.01), 但观察组改善更为明显(P<0.01)。观察组出院后随访6个月心脏不良事件发生率5.56%, 低于对照组的22.22%(P<0.05)。结论: 尼可地尔对缺血性心肌病患者的心功能具有一定的改善作用, 值得临床推广应用。

Effect of the nicorandil on the cardiac functions of patients with ischemic cardiomyopathy

Objective:To discuss the effects of nicorandil on the cardiac functions of patients with ischemic cardiomyopathy. Methods:Seventy-two ischemic cardiomyopathy patients treated without vascular remodeling were randomly divided into the observation group and control group(36 cases each group). All patients were treated with aspirin,diuretic,digitalis,angiotensin converting enzyme inhibitor,clopidogrel,aldosterone antagonist,nitrate and beta blocker. The observation group were additionally treated with nicorandil. The level of BNP,6 minutes walking distance and echocardiography between two groups before treatment and after 6 months of treatment were analyzed. The major adverse cardiac events of all patients were recorded during the hospitalization and after 6 months of discharge. Results:The effective rate in observation group(97. 2%) was significantly higher than that in control group(80. 6%)(P<0. 05). The improvement of left ventricular end-diastolic volume, left ventricular end-systolic volume, early diastolic mitral inflow velocity/late diastolic mitral inflow velocity in observation group were better than those in control group(P<0. 05 to P<0. 01). The difference of the improvement of left ventricular ejection fraction between two groups was not statistically significant(P >0.05). The major adverse cardiac events of all patients were recorded during the hospitalization and after 6 months of discharge. Compared with before treatment, the 6 minutes walking distance and BNP in two groups were improved after treatment(P<0. 01),especially in the observation group (P<0. 01). After following-up for 6 months,the incidence of cardiac adverse event in observation group(5. 56%) was lower than that in control group(22. 22%) (P <0. 05). Conclusions:The nicorandil can improve the cardiac functions of patients with ischemic cardiomyopathy,which is worthy of clinical application.