尼可地尔对急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术后的临床效果观察

目的探讨尼可地尔治疗急性ST段抬高型心肌梗死的效果。方法选取2018年5月至2019年5月山西医科大学附属运城医院心内科收治的121例急性前壁ST段抬高型心肌梗死并接受急诊经皮冠状动脉介入(PCI)治疗的患者,男101例,女20例,年龄(61.35±3.93)岁,年龄范围为46~77岁,采用随机数表法将其随机分为常规用药组(n=61)与尼可地尔组(n=60)。常规用药组患者接受冠状动脉粥样硬化性心脏病二级预防用药,尼可地尔组在常规用药组的基础上术前经冠状动脉注射尼可地尔4 mg,术后口服尼可地尔5 mg,每日3次,持续6个月,观察两组患者介入术中慢血流和无复流的发生情况、心肌梗死溶栓试验(TIMI)血流分级、血清心肌超敏肌钙蛋白T水平及术后住院期间心力衰竭和心律失常的发生情况,观察两组患者术后6个月心脏事件的发生情况(包括再发心肌梗死、充血性心力衰竭、再住院、全因死亡),记录治疗期间两组患者心绞痛发生情况,持续治疗6个月,评价并比较两组患者临床治疗效果。结果行急诊PCI术后24 h,尼可地尔组超敏肌钙蛋白T水平[(4407±809)pg/ml]低于常规用药组[(7456±1028)pg/ml],差异有统计学意义(P<0.05)。尼可地尔组心力衰竭的发生率[6.6%(4/61)]低于常规用药组[20.0%(12/60)],心律失常的发生率[9.8%(6/61)]低于常规用药组[23.3%(14/60)],差异有统计学意义(P<0.05)。尼可地尔组患者心绞痛复发率[6.6%(4/61)]低于常规用药组[23.3%(14/60)],差异有统计学意义(P<0.05)。结论持续尼可地尔治疗可以降低急性ST段抬高型心肌梗死患者心肌损伤,改善急性ST段抬高型心肌梗死的短期治疗效果,改善患者长期的心功能,值得在临床上推广应用。

Clinical effect of Nicorandil on patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention

Objective To investigate the effects of nicorandil(NIC)on patients with acute anterior myocardial infarction(AMI).Methods A retrospective study was performed on 121 cases of patients with acute anterior wall ST segment elevation myocardial infarction and receive emergency percutaneous coronary intervention(PCI),101 cases of male,female 20 cases,aged(61.35±3.93)years old,ranging from 46 to 77 years,by using the method to stochastic indicator were randomly divided into conventional treatment group(n=61)and nicorandil group(n=60).Conventional treatment group receiving coronary atherosclerotic heart disease in patients with secondary prevention medicine,nicorandil group in the conventional treatment group on the basis of preoperative via coronary artery injection,can to 4 mg,postoperative oral 5 mg,three times a day,for six months,observed in two groups of patients in slow blood flow and the occurrence of no reflow,myocardial infarction,thrombolysis trial(TIMI)flow grade,serum myocardial hypersensitive troponin level and the occurrence of postoperative hospitalization for heart failure and arrhythmia,the occurrence of cardiac events(including recurrent myocardial infarction,congestive heart failure,rehospitalization,and all-cause death)in the two groups was observed 6 months after the operation.The occurrence of angina pectoris in the two groups during the treatment period was recorded.Results The 24 hours after emergency PCI,the level of hypersensitive troponin in nicorandil group[(4407±809)pg/ml]was lower than that in the conventional group[(7456±1028)pg/ml],with statistically significant difference(P<0.05).The incidence of heart failure[6.6%(4/61)]in the nicorandil group was lower than that in the conventional group[20.0%(12/60)],and the incidence of arrhythmia[9.8%(6/61)]was lower than that in the conventional group[23.3%(14/60)],with statistically significant differences(P<0.05).The recurrence rate of angina pectoris in the nicorandil group[6.6%(4/61)]was lower than that in the conventional group[23.3%(14/60)],and the difference was statistically significant(P<0.05).Conclusion Continuous nicorandil therapy can reduce myocardial injury in patients with acute ST-segment elevation myocardial infarction,improve short-term therapeutic effect of acute ST-segment elevation myocardial infarction,and improve long-term cardiac function of patients,which is worthy of clinical application.