本文選題：心肌梗死　切入點：血管成形術　出處：《中國全科醫(yī)學》2017年23期

【摘要】：目的觀察無復流現(xiàn)象(NRP)發(fā)生前冠狀動脈靶血管內注射尼可地爾對急性ST段抬高型心肌梗死(STEMI)患者急診經(jīng)皮冠狀動脈介入治療(PCI)術中NRP的預防效果。方法選擇2015年1月—2016年9月河北醫(yī)科大學第三醫(yī)院收治的需行急診PCI術的急性STEMI患者105例,采用隨機數(shù)字表法分為尼可地爾組、硝普鈉組和對照組,每組各35例。尼可地爾組采用球囊擴張及加壓泵于靶血管向靶病變遠端2 mm處預先注射尼可地爾2 mg、硝普鈉組注射硝普鈉200μg、對照組注射0.9%氯化鈉溶液。觀察PCI術前及結束時梗死相關血管心肌梗死溶栓試驗(TIMI)血流分級、校正TIMI血流幀數(shù)(c TFC)、TIMI心肌灌注分級(TMPG)、術中NRP發(fā)生率及術后90 min ST段回落率(STR),PCI術前及術后1周時檢測N末端腦鈉肽前體(NT-pro BNP);PCI術前及術后每4 h檢測肌酸激酶同工酶(CK-MB)及肌鈣蛋白I(c Tn I),記錄其峰值水平。PCI術前及術后1周時采用心臟彩超計算室壁運動積分指數(shù)(WMSI)及左心室射血分數(shù)(LVEF)。觀察PCI術中低血壓發(fā)生情況及術后預后情況。結果 3組患者術前TIMI血流分級、達到TMPG 3級的比例、NT-pro BNP、CK-MB、c Tn I、WMSI及LVEF比較,差異均無統(tǒng)計學意義(P0.05)。硝普鈉組和尼可地爾組患者術后c TFC及NRP發(fā)生率較對照組降低,術后達到TMPG 3級的比例及STR≥50%的比例較對照組升高(P0.05);硝普鈉組和尼可地爾組患者術后NT-pro BNP、CK-MB峰值、c Tn I峰值、WMSI較對照組降低,術后LVEF較對照組升高(P0.05)。硝普鈉組與尼可地爾組患者c TFC、術后達到TMPG 3級的比例、NRP發(fā)生率、STR≥50%的比例、術后NT-pro BNP、CK-MB峰值、c Tn I峰值、WMSI及LVEF比較,差異均無統(tǒng)計學意義(P0.05)。對照組、硝普鈉組及尼可地爾組術中分別有3例(9.1%)、8例(24.2%)及0例發(fā)生低血壓,需多巴胺處理,3組低血壓發(fā)生率比較,差異有統(tǒng)計學意義(χ2=10.236,P=0.006);其中硝普鈉組低血壓發(fā)生率較尼可地爾組升高(P0.01)。3組PCI術后3個月主要心臟不良事件(MACEs)發(fā)生率分別為:15.2%(5/33)、6.1%(2/33)及5.9%(2/34),差異無統(tǒng)計學意義(χ2=2.276,P=0.320)。結論 NRP發(fā)生前冠狀動脈靶血管內注射尼可地爾可安全、有效地預防急性STEMI患者急診PCI術中NRP發(fā)生,并改善心肌灌注水平和心功能。
[Abstract]:Objective to observe the preventive effect of intracoronary intravascular injection of nicorandil on NRP during emergency percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction (STEMI) before reflow. From January to September 2016, 105 patients with acute STEMI who needed emergency PCI operation were admitted to the third Hospital of Hebei Medical University. The patients were randomly divided into three groups: nicorandil group, sodium nitroprusside group and control group. In each group, 35 cases were treated by balloon dilatation and pressure-pump injection of nicorandil 2 mg at 2 mm to the distal end of the target, sodium nitroprusside 200 渭 g and control group 0.9% sodium chloride solution. PCI was observed. Thrombolytic test (TIMIT) was performed before and at the end of infarct related vessel myocardial infarction. Adjusted TIMI blood flow frame count and myocardial perfusion grade of TIMI, the incidence of NRP during operation and the rate of St segment fall after 90 min were measured before and 1 week after PCI to detect the isoenzyme of creatine kinase before and every 4 hours after PCI. The peak level of CK-MBand cardiac troponin C Tn I were recorded. The ventricular wall motion score (WMSI) and left ventricular ejection fraction (LVEF) were calculated by color Doppler echocardiography before and 1 week after PCI. The incidence of hypotension and postoperative prognosis in PCI were observed. Results TIMI blood flow grading was performed in 3 groups before operation. There was no significant difference in NT-pro BNPCK-MBC TMPG and LVEF. The incidence of c TFC and NRP in sodium nitroprusside group and nicorandil group was lower than that in control group. The proportion of patients with TMPG grade 3 and STR 鈮，

本文編號：1674275