Effect of nicorandil combined with myocardial ischemic postconditioning on myocardial per-fusion and prognosis in patients with STEMI undergoing PPCI
卜云涛 1丁超 1刘文秀 1王刚 1程锦浩1
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作者信息
1. 中国人民解放军联勤保障部队第980医院心血管内科,河北石家庄 050000
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摘要
目的 观察尼可地尔联合缺血后适应(MIP)对急性ST段抬高心肌梗死(STEMI)患者急诊直接经皮冠脉介入术(PPCI)心肌血流灌注及预后的影响.方法 选取急诊行PPCI的STEMI患者200例,随机均分为对照组(PPCI)、尼可地尔组(PPCI+尼可地尔)、MIP组(PPCI+MIP)、联合组(PPCI+尼可地尔+MIP).比较4组患者心肌血流灌注恢复、心肌损伤、心功能和预后的差异.结果 与对照组比较,尼可地尔组、MIP组及联合组术后即刻TIMI血流帧数、术后24 h肌钙蛋白Ⅰ(cTnⅠ)和肌酸激酶同工酶(CK-MB)、术后72 h cTnⅠ降低,尼可地尔组及联合组术后无复流发生率降低,联合组术后12个月N末端B型脑钠肽前体、术后7天心律失常严重程度评分、12个月内心衰和心绞痛再住院率降低,尼可地尔组及联合组术后2 h ST段回落率升高(P＜0.05).联合组术后24 h CK-MB显著低于尼可地尔组(P＜0.05).结论 尼可地尔联合MIP在心肌血流灌注恢复、降低心肌损伤及改善患者预后方面的效果值得肯定.
Abstract
Aim To observe the effect of nicordil combined with myocardial ischemic postconditioning(MIP)on myocardial perfusion and prognosis in patients with acute ST segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).Methods A total of 200 STEMI patients receiving PPCI in the emergency department were ran-domly divided into control group(PPCI),nicodil group(PPCI+nicodil),MIP group(PPCI+MIP),and combination group(PPCI+nicodil+MIP).The differences of myocardial blood perfusion recovery,myocardial injury,cardiac function and prognosis in 4 groups were observed and compared.Results Compared with the control group,immediate postoperative TIMI blood flow frame rate,cardiac troponin Ⅰ(cTnⅠ)and creatine kinase isoenzyme(CK-MB)at 24 h post-operation,and cTnⅠ at 72 h after operation were de-creased in nicorandil group,MIP group and joint group.The incidence of postoperative no reflow in the nicorandil group and combi-nation group were decreased.The combination group showed a decrease in CK-MB at 72 h post-surgery,N-terminal B-type brain na-triuretic peptide precursor at 12 months post-surgery,arrhythmia severity score at 7 days post-surgery,and readmission rate due to heart failure.The ST segment regression rate increased 2 hours after surgery in the nicorandil group and combination group(P＜0.05).The postoperative CK-MB of the combination group was significantly lower than that of the nicorandil group at 24 h(P＜0.05).Conclusion The effect of nicodil combined with MIP on myocardial perfusion recovery,myocardial injury reduction and the improvement of prognosis of patients is worthy of recognition.
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