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。
Effect of nicorandil combined with myocardial ischemic postconditioning on myocardial per-fusion and prognosis in patients with STEMI undergoing PPCI
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.
万方数据
维普
