尼可地尔对急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入术后临床效果的影响

目的 观察冠状动脉联合外周静脉应用尼可地尔对急性ST段抬高型心肌梗死（STEMI）患者直接经皮冠状动脉介入（PPCI）治疗术后心肌微循环及短期预后的影响。方法 100例接受PPCI治疗的急性STEMI患者，根据不同给药方式分为尼可地尔组和对照组，每组各50例。尼可地尔组于PPCI术中开通靶血管即刻予冠状动脉注射尼可地尔并静脉持续泵入24 h，对照组于PPCI术中予冠脉注射生理盐水并静脉持续泵入24 h。主要观察指标为PPCI术后即刻冠脉血流及心肌血流灌注情况，包括介入术后TIMI血流分级、校正TIMI帧计数（CTFC）、再灌注心律失常、ST段回落、肌酸激酶同工酶（CK-MB）达峰时间及峰值，次要观察指标为住院期间主要不良心血管事件（MACE）及左心室射血分数（LVEF）。结果 2组内手术前后肝肾功能、心率、血压变化差异无统计学意义（均P＞0.05）。与对照组相比，PPCI术后尼可地尔组再灌注心律失常发生比例、慢血流/无复流比例、住院期间MACE比例、CTFC、CK-MB峰值降低；TIMI 3 级血流患者比例、CK-MB 达峰时间提前至 14 h 内的比例、ST 段回落的比例均明显增加（均 P＜0.05）。2组患者住院期间LVEF差异无统计学意义（P＞0.05）。结论 冠脉联合外周静脉应用尼可地尔有助于实现STEMI患者PPCI术后梗死血管的血运重建，减少慢血流/无复流的发生，限制梗死面积，增加心肌血流灌注，改善心肌微循环和短期预后。

The effects of nicorandil on clinical outcome after primary percutaneous coronaryintervention in patients with acute ST-segment elevation myocardial infarction

Objective To evaluate the effects of combined intracoronary and intravenous administration of nicorandilon myocardial microcirculation and short-term prognosis in patients with acute ST-segment elevation myocardial infarction(STEMI) treated with primary percutaneous coronary intervention (PPCI). Methods A total of 100 patients with acuteSTEMI underwent PPCI were randomly divided into the nicorandil group (patients received intracoronary bolus injection ofnicorandil when the target vessel opened and then continuous intravenous infusion within 24 hours, n=50) and the controlgroup (patients received normal saline as control, n=50). The main outcome measures were immediate coronary flow andmyocardial perfusion after PPCI, including thrombo-Lysis in myocardial infarction (TIMI) flow grade, corrected TIMI framecount (CTFC), reperfusion arrhythmia, ST-segment resolution, plasma creatine kinase isoenzyme (CK-MB) peak value andtime. The secondary indicators were major adverse cardiovascular events (MACE) and left ventricular ejection fraction(LVEF) during hospitalization. Results There were no significant differences in hepatorenal function, heart rate and bloodpressure before and after operation in each group (P＞0.05). The incidence of reperfusion arrhythmia, the level of MACE,CTFC, and peak value of CK-MB were all significantly lower in the nicorandil group compared with those of control group(P＜0.05). The proportions of patients with TIMI 3 flow, CK-MB peak time in 14 hours, and the proportion of ST-segment resolution were significantly higher in the nicorandil group than those of the control group (all P＜0.05). There was nosignificant difference in LVEF during hospitalization between two groups (P＞0.05). Conclusion Intracoronary andintravenous administration of nicorandil can significantly improve revascularization effects, reduce the occurrence of slowflow/no reflow, limit myocardial infarction size, increase myocardial perfusion and improve myocardial microcirculation andthe short-term prognosis of acute STEMI patients.