本文選題：慢血流　切入點：尼可地爾　出處：《河北醫(yī)科大學》2017年碩士論文

【摘要】：目的:冠狀動脈慢血流現(xiàn)象(coronary slow flow phenomenon,CSFP)是一種特殊的冠狀動脈微血管疾病,其發(fā)生機制不明確,治療方法有限。本研究采用冠狀動脈內注射尼可地爾(nicorandil)的方法,通過注射前及注射后1、3、5、10分鐘造影劑充盈血管末端幀數(shù)的變化,觀察尼可地爾對CSFP的即時效果。方法:選取2014年10月至2016年12月因胸痛在河北醫(yī)科大學第三醫(yī)院心血管一科行冠狀動脈造影(coronary angiography,CAG)證實心外膜主要冠狀動脈無狹窄病變、存在CSFP的患者56例。冠狀動脈血流緩慢定義為造影劑在3個心動周期內不能到達血管末端。根據(jù)住院號尾數(shù)將患者隨機分為2組,住院號尾數(shù)為偶數(shù)列為試驗組,奇數(shù)列為對照組。試驗組共36例,經(jīng)冠狀動脈造影導管向冠狀動脈內注射尼可地爾2mg(4mg/min),以TIMI幀計數(shù)(TFC)法定量評價冠狀動脈血流,記錄給藥前及給藥后1min、3min、5min、10min時冠狀動脈內TFC值;對照組共20例,經(jīng)冠狀動脈造影導管向冠狀動脈內注射硝酸甘油200μg(400μg/min),同上方法觀察TFC值變化,同時記錄給藥前后試驗組和對照組的心率,收縮壓和舒張壓。結果:1基本資料:兩組患者臨床基本特征相似,差異無統(tǒng)計學意義,參見表1。2兩組用藥前后TFC值變化:試驗組中LAD、RCA及LCX內應用尼可地爾后1分鐘TFC值最低,1分鐘時TFC值與給藥前、給藥后3分鐘、5分鐘、10分鐘比較均有顯著性差異(P0.001)。對照組LAD內應用硝酸甘油后1分鐘TFC值最低,1分鐘TFC值與給藥前、給藥后3分鐘、5分鐘、10分鐘比較均有顯著性差異(P0.001)。對照組LCX、RCA內應用硝酸甘油后1分鐘時TFC值最低,但1分鐘時TFC值與給藥前、給藥后3、5、10分鐘比較差異無統(tǒng)計學意義(P0.05)。試驗組和對照組在給藥1分鐘時TFC變化最明顯,通過比較兩組在1分鐘時TFC的減少百分比,對比兩種藥物效果。試驗組LAD、LCX內TFC減少百分比大于對照組,且有顯著性差異(P0.05);試驗組RCA內TFC值減少百分比與對照組比較差異無統(tǒng)計學意義(P0.05)。3兩組用藥前后心率及血壓變化:試驗組冠狀動脈內注射尼可地爾前及用藥后1、3、5、10分鐘,心率無明顯變化;對照組冠狀動脈內注射硝酸甘油前及用藥后1、3、5、10分鐘心率比較,1分鐘時心率最高;試驗組和對照組冠狀動脈內注射藥物前及用藥后1、3、5、10分鐘,收縮壓、舒張壓在1分鐘時最低。結論:1冠狀動脈內注射尼可地爾和硝酸甘油均可改善CSFP中的TFC。2冠狀動脈內注射尼可地爾在CSFP中降低TFC的即刻效應優(yōu)于硝酸甘油。3冠狀動脈內注射尼可地爾在給藥后1min作用最明顯,5分鐘后TFC恢復到用藥前水平,作用時間短暫。
[Abstract]:Objective: coronary slow flow (CSFP) is a special coronary microvascular disease with unclear mechanism and limited treatment.In this study, intracoronary injection of nicoranil was used to observe the immediate effect of nicorandil on CSFP.Methods: from October 2014 to December 2016, 56 patients with CSFP were selected from the Department of Cardiovascular and Cardiovascular Department of the third Hospital of Hebei Medical University, from October 2014 to December 2016, to confirm that there was no stenosis in the main epicardial coronary artery.Slow coronary flow is defined as a contrast agent that fails to reach the end of the vessel during three cardiac cycles.Patients were randomly divided into two groups according to the Mantissa of the hospitalization number. The Mantissa of the hospitalization number was even as the experimental group and the odd number as the control group.A total of 36 patients in the trial group were treated with intracoronary injection of nicorandil (2mg / min) into the coronary artery via coronary angiography catheter. Coronary blood flow was evaluated by TIMI frame counting (TIMI frame count) method, and the coronary TFC values were recorded before and 1 min after administration of the drug, and 20 cases in the control group.Nitroglycerin 200 渭 g / min was injected into the coronary artery via coronary angiography catheter. The changes of TFC were observed. Heart rate, systolic blood pressure and diastolic blood pressure were recorded before and after administration of the drug.Results: the clinical characteristics of the two groups were similar, but the difference was not statistically significant.See Table 1.2 changes of TFC values before and after administration in two groups: there were significant differences in TFC values between the two groups before and after administration of LADX RCA and LCX at the lowest TFC value in 1 minute and before administration and at 3 minutes and 5 minutes and 10 minutes after administration respectively (P 0.001).In the control group, the lowest TFC value was 1 minute after the application of nitroglycerin and the lowest one minute TFC value in the control group. There were significant differences between the control group and the control group before administration of nitroglycerin and 3 minutes and 5 minutes and 10 minutes after administration of nitroglycerin (P 0.001).In the control group, the TFC value was the lowest at 1 minute after nitroglycerin administration, but there was no significant difference between the TFC value at 1 minute and that before and after 3 minutes of administration for 10 minutes (P 0.05).The changes of TFC were most obvious in the experimental group and the control group at 1 minute. The effect of the two drugs was compared by comparing the percentage of decrease of TFC in the two groups at 1 minute.The percentage of TFC reduction in LADL-LCX in the trial group was higher than that in the control group.There was no significant difference in the percentage of TFC reduction in RCA between the two groups before and after administration of P0.053.The changes of heart rate and blood pressure in the two groups were as follows: before and after intracoronary injection of nicorandil in the trial group, the changes of heart rate and blood pressure were 10 minutes before and after intracoronary injection of nicordil, and there was no significant difference in the percentage of TFC in the trial group compared with the control group.There was no significant change in heart rate, the heart rate was the highest in the control group before and after the injection of nitroglycerin in the coronary artery, and the systolic blood pressure in the experimental group and the control group was 510 minutes before and after the intracoronary injection of nitroglycerin, and the heart rate in the control group was higher than that in the control group before and after the injection of nitroglycerin.Diastolic blood pressure is lowest in 1 minute.Conclusion both intracoronary nicorandil and nitroglycerin can improve the immediate effect of intracoronary nicorandil injection in CSFP on reducing TFC in CSFP, which is better than that of nitroglycerin 3 intracoronary injection of nicorandil in CSFP.The effect of 1min was the most obvious after 5 minutes. The level of TFC returned to the pre-medication level.The action time is short.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R543.3

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