【摘要】 目的 通过观察早期口服尼可地尔对老年急性ST段抬高心肌梗死(STEMI)患者急诊PCI术后的心肌受损程度、冠脉微循环灌注水平、心脏功能的影响及主要不良心脏事件(MACE),探讨尼可地尔对老年急性ST段抬高心肌梗死患者心肌保护作用。方法 2013年7月至2015年1月入院的115例行急诊PCI的老年STEMI患者(>60岁),随机分为尼可地尔组57例和对照组58例。入院确诊后尼可地尔组患者即刻顿服尼可地尔15 mg,对照组仅行再灌注治疗;术后尼可地尔组继续口服尼可地尔5 mg,3次/d,而对照组口服单硝酸异山梨酯片20 mg,3次/d。监测手术前后心肌损伤标志物肌钙蛋白。术中记录所有患者梗死相关动脉情况、PCI后校正TIMI帧数(CTFC)及心肌灌注分级(TMP)。PCI术后1周行超声心动图检查,记录左室射血分数(LVEF)及左室舒张末期内径(LVEDD)。记录PCI术后30 d主要不良心脏事件(MACE)。结果两组患者PCI术后12 h、24 h静脉血cTnI检测结果 均较术前明显升高,但尼可地尔组明显低于对照组(P<0.05)。尼可地尔组术后校正的TIMI帧数(CTFC)小于对照组(29.64±3.18比32.70±4.55,P<0.05);心肌灌注分级TMP 2级以上的比例尼可地尔组高于对照组(78.95%比62.07%,P<0.05)。尼可地尔组患者的射血分数高于对照组(54.36±5.03比51.09±4.45,P<0.05)。PCI术后30 d尼可地尔组MACE发生率低于对照组(7.02%比20.69%,P<0.05)。结论 早期口服尼可地尔可减轻老年急性ST段抬高心肌梗死患者急诊PCI术后的心肌受损程度,改善心肌微循环灌注,保护左心室功能,减少MACE事件发生。更多还原

【Abstract】 Objective To explore the cardioprotection of early oral Nicorandil treatment in old patients with acute ST-elevation myocardial infarction undergoing primary PCI by observing myocardial damage,coronary microcirculation perfusion,cardiac function and MACE.Methods 115 old patients(>60 years old) with ST elevation myocardial infarction(STEMI) who underwent emergency PCI were randomly divided into two groups which were the Nicorandil group(n=57) and the control group(ra=58).The patients in Nicorandil group received dose of Nicorandil 15 mg immediately after admission.The patients in Nicorandil group received 5 mg oral Nicorandil three times a day after PCI,while in control group received 20 mg oral Isosorbide mononitrate tablets three times a day.The PCI data and cTnI were collected.LVEF 1 week after PCI and MACE within 30 day after PCI were compared between the two groups.Results Levels of cTnI in Nicorandil group were less than those in control group at 12 and 24 hours after PCI(P<0.05).The CTFC was fewer in the Nicorandil group(29.64±3.18 vs.32.70±4.55,P<0.05) after PCI.The percentage of TMP beyond 2 grade was higher in the Nicorandil group(78.95%vs.62.07%,P<0.05).The LVEF was higher in the Nicorandil group(54.36±5.03 vs.51.09±4.45,P<0.05).There was a lower MACE in the Nicorandil group compared with the control group in 30 days(7.02%vs.20.69%,P<0.05).Conclusion Nicorandil can alleviate myocardial injury,improve myocardial microcirculation perfusion,protect cardiac function and decrease the MACE.更多还原