王晓会.急性心肌梗死患者经皮冠状动脉介入术中冠脉注射尼可地尔的临床评估[J].内科急危重症杂志,2020,26(3):194-198
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| DOI：10.11768/nkjwzzzz20200305 |
| 中文关键词: 急性心肌梗死 急诊经皮冠状动脉介入术 尼可地尔 三碘甲状腺原氨酸 血浆凝溶胶蛋白 |
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| 中文摘要: |
| 目的：探讨急性心肌梗死(AMI)患者经皮冠状动脉介入（PCI）术中冠脉注射尼可地尔对血浆凝溶胶蛋白(pGSN) 与三碘甲状腺原氨酸（T3）表达水平的影响。方法：按照随机数字表法将90例AMI患者分为研究组和对照组，每组45例。研究组通过加压泵及球囊扩张在靶血管向靶病变远端2mm 处注射2mg尼可地尔溶液，对照组于相同位置注射等容量0.9%氯化钠溶液。观察2组患者PCI术前、后的梗死相关血管心肌梗死溶栓试验(TIMI) 血流分级、TIMI 心肌灌注分级 (TMPG)及血清N 末端B型脑钠肽前体( NT proBNP)、肌酸激酶同工酶(CK MB)及心肌肌钙蛋白I(cTnI)水平，比较2组患者的室壁运动积分指数(WMSI)、左心室射血分数( LVEF)、pGSN 及血T3水平，并记录不良反应发生情况。结果：PCI术后2组TIMI血流分级比较，差异有统计学意义（P＜0.05）。研究组校正后的TIMI血流帧数 (cTFC)、无复流现象（NRP）发生率、血浆NT proBNP、cTnI、CK MB水平、WMSI、PCI术中低血压发生率及术后3个月的主要不良心血管事件（MACEs）发生率显著低于对照组（均P＜0. 05），研究组ST段回落率(STR)≥50%、术后TMPG 3级比例及LVEF显著高于对照组（均P＜0. 05）。术后2组患者血清T3及pGSN水平较治疗前均明显升高，且研究组高于对照组（均P＜0.05）。结论：AMI患者PCI术中冠脉注射尼可地尔可显著改善患者心功能和心肌灌注水平，提高血清T3及pGSN表达水平，且安全性高。 |
| 英文摘要: |
| Objective: To investigate the effect of coronary injection of nicorandil on the expression of plasma gelsolin (pGSN) and triiodothyronine (T3) in patients with acute myocardial infarction (AMI) undergoing emergency percutaneous coronary intervention (PCI). Methods: According to the random number table method, 90 patients with AMI were divided into study group and control group, 45 cases in each group. The study group was given injection of 2 mg of nicorandil solution into the target vessel 2 mm distal to the target lesion by a compression pump and balloon dilation, and the control group was injected with an equal volume of 0.9% sodium chloride solution at the same position. The infarction-related vascular myocardial infarction thrombolysis (TIMI) blood flow grading, TIMI myocardial perfusion fraction (TMPG), and N-terminal pro-brain natriuretic peptide (NT-proBNP), creatine kinase isoenzyme (CK-MB) and troponin I (cTnI) levels were observed and compared, and wall motion score index (WMSI) and left ventricular ejection fraction (LVEF), pGSN and serum T3 levels were measured, and the adverse reactions were recorded. Results: the TIMPI blood flow classification after PCI between the two groups was statistically significant (P<0.05). The corrected number of blood flow frames (cTFC), no reflow phenomenon (NRP) incidence, plasma NT-proBNP, cTnI, CK-MB, WMSI, the incidence of intraoperative hypotension and major cardiac adverse events (MACEs) at 3rd month after operation in the study group were significantly lower than those in the control group (all P<0.05). The STR ≥ 50%, TMPG 3 grades and LVEF in the study group were significantly higher than those in the control group (all P<0.05). Postoperative serum T3 and pGSN levels in both groups were significantly higher than before treatment, and those in the study group were significantly higher than in the control group (all P<0.05). Conclusion: Coronary injection of nicorandil in patients with AMI can significantly improve cardiac function and myocardial perfusion level, and increase serum T3 and pGSN expression levels. It is safe and suitable for clinical application. |
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