文献类型：期刊文献

中文题名：尼可地尔预处理对非ST段抬高型急性冠状动脉综合征患者无复流现象的预防效果

英文题名：Prevention of no-reflow by intravenous nicorandil for patients with non-ST-segment elevation acute coronary syndrome

作者：郭丽霞[1];张兰[2];姜潇思[3];田立超[3];孙志军[3];陈韵岱[3];钱赓[3]

第一作者：郭丽霞

机构：[1]北京联合大学校医院;[2]军委政治工作部机关门诊部;[3]中国人民解放军总医院心内科

第一机构：北京联合大学校医院

年份：2019

卷号：27

期号：3

起止页码：140-144

中文期刊名：中国介入心脏病学杂志

外文期刊名：Chinese Journal of Interventional Cardiology

收录：CSTPCD

基金："十三五"重大新药创制课题(2018ZX09201-013);心馨-默克心血管科研基金(2017-CCAxinxinmerck fund-003)

语种：中文

中文关键词：急性冠状动脉综合征;尼可地尔;无复流

外文关键词：Acute coronary syndrome;Nicorandil;No-reflow

摘要：目的分析在非ST段抬高型急性冠状动脉综合征患者行经皮冠状动脉介入治疗(PCI术前使用尼可地尔预处理,从而减少PCI术中慢血流/无复流的总体效果。方法选自2017年1月至2017年12月在中国人民解放军总医院接受PCI术的非ST段抬高型急性冠状动脉综合征患者共1460例,随机分为尼可地尔干预组(728例)和对照组(732例)。其中尼可地尔干预组在术前使用尼可地尔预处理24 h,静脉滴注2 mg/h,在PCI术中观察患者支架置入术后冠状动脉血流灌注情况,评估靶血管开通后远端前向血流(TIMI血流分级),术后复查血生化结果并进行统计学分析,观察患者围术期并发症情况。结果入组患者平均年龄为(61.1±10.2)岁,男性76.1%(1111/1460),急性非ST段抬高型心肌梗死14.9%(217/1460)。两组患者心血管主要危险因素以及血生化指标比较,差异均无统计学意义(均P>0.05)。两组患者围术期使用规范的抗血小板药物和他汀类药物治疗比例比较,差异均无统计学意义(均P>0.05);两组在围术期使用β阻滞药、血管紧张素转换酶抑制药/血管紧张素Ⅱ受体拮抗药、钙通道阻滞药治疗比例比较,差异均无统计学意义(均P>0.05)。两组患者行冠状动脉支架置入术比例比较(97.9%比98.5%, P=0.437),差异无统计学意义。尼可地尔干预组患者术中无复流发生率(2.3%比4.4%,P=0.021)、围术期出现心肌损伤比例(5.9%比8.7%,P=0.024)比较,差异均有统计学意义。结论PCI术前使用尼可地尔预处理非ST段抬高型急性冠状动脉综合征患者可以有效预防术中无复流事件发生,有效保护心肌组织。
Objective To explore the effect of nicorandil pretreatment on prevention of no-reflow in patients with non-ST-segment elevation acute coronary syndrome.Methods Since January 2017 to December 2017,a total of 1460 patients with non-ST-segment elevation acute coronary syndrome undergoing PCI in our hospital were randomized to either intravenous nicorandil intervention group(n=728)or control group(n=732).The patients in nicorandil group received continuous intravenous infusion of nicorandil before the PCI procedure.TIMI score by results of coronary angiography,and cardiac troponin T before and after PCI were evaluated.Results The average age of the patients was 61 years old,76.1%(1111/1460)was male,and 14.9%of the patients were acute non-ST-segment elevation myocardial infarction(217/1460).There was no significant diff erence in clinical characteristics between two groups.The incidence of no-reflow in the intervention group was significantly lower than that in the control group(2.34%vs.4.37%,P=0.021),and the incidence of myocardial injury in the perioperative period was significantly lower than control group(5.91%vs.8.74%,P=0.024).Conclusions Intravenous administration of nicorandil before PCI could improve the blood flow after PCI in patients with non-ST-segment elevation acute coronary syndrome,and it is associated with a reduction of myocardial injury during perioperative period.