本文選題：前列地爾 + 尼可地爾�。� 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:冠狀動(dòng)脈粥樣硬化性心臟病是目前威脅全人類身體健康的主要疾病之一,它的治療效果及預(yù)后狀況備受廣泛關(guān)注和高度重視。經(jīng)皮冠脈介入治療是目前臨床常用的一種血運(yùn)重建的治療方法。本文旨在臨床觀察同時(shí)應(yīng)用前列地爾和尼可地爾對(duì)行經(jīng)皮冠脈介入治療的不穩(wěn)定型心絞痛患者心肌損傷保護(hù)作用的探討。方法:選擇于青島大學(xué)醫(yī)學(xué)院附屬醫(yī)院心血管內(nèi)科門診就診且確診為不穩(wěn)定型心絞痛,需住院行PCI手術(shù)的患者120例作為研究對(duì)象,隨機(jī)分為4組,每組各30例。對(duì)照組入院后據(jù)相關(guān)指南給予不穩(wěn)定型心絞痛的常規(guī)藥物治療;前列地爾組在常規(guī)藥物治療的同時(shí),術(shù)前48小時(shí)及術(shù)后給以前列地爾每次10μg靜脈推注,每日一次;尼可地爾組在常規(guī)藥物治療的同時(shí),術(shù)前48小時(shí)及術(shù)后給以尼可地爾口服制劑每頓5mg,一天三次;兩種藥混合實(shí)驗(yàn)組在常規(guī)藥物治療的基礎(chǔ)上,術(shù)前48小時(shí)及術(shù)后同時(shí)給予前列地爾每次10μg靜脈推注,每日一次及尼可地爾口服制劑每頓5mg,一天三次的治療。觀察比較以上四組PCI治療前及治療后6、12、18、24小時(shí)血清肌酸激酶同工酶(CK-MB)、超敏C反應(yīng)蛋白(hs-CRP)、高敏肌鈣蛋白T(hs-c Tn T)的水平。結(jié)果:對(duì)照組、前列地爾組、尼可地爾組和兩種藥混合實(shí)驗(yàn)組,四組受試者在PCI治療前研究對(duì)象的一般狀況和PCI術(shù)中所見的冠脈病變數(shù)、支架植入數(shù)比較均無(wú)顯著性差異(P0.05)。對(duì)照組和三個(gè)治療組的心肌損傷標(biāo)志物和超敏C反應(yīng)蛋白(hs-CRP)在冠脈介入治療術(shù)后四個(gè)時(shí)間段均較冠脈介入治療術(shù)前有所上升。前列地爾組和尼可地爾組患者的血清肌酸激酶同工酶(CK-MB)、超敏C反應(yīng)蛋白(hs-CRP)、高敏肌鈣蛋白T(hs-c Tn T)的水平在PCI術(shù)后6、12、18、24h各自均低于對(duì)照組相應(yīng)時(shí)間點(diǎn)水平,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩種藥混合實(shí)驗(yàn)組患者的血清肌酸激酶同工酶(CK-MB)、超敏C反應(yīng)蛋白(hs-CRP)、高敏肌鈣蛋白T(hs-c Tn T)的水平在PCI術(shù)后6、12、18、24h均明顯低于對(duì)照組相應(yīng)時(shí)間點(diǎn)水平,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩種藥混合實(shí)驗(yàn)組患者的血清肌酸激酶同工酶(CK-MB)、超敏C反應(yīng)蛋白(hs-CRP)、高敏肌鈣蛋白T(hs-c Tn T)的水平在PCI術(shù)后6、12、18、24h均分別低于前列地爾組和尼可地爾組的相應(yīng)時(shí)間點(diǎn)水平,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。前列地爾組和尼可地爾組患者的血清肌酸激酶同工酶(CK-MB)、超敏C反應(yīng)蛋白(hs-CRP)、高敏肌鈣蛋白T(hs-c Tn T)的水平在PCI術(shù)后6、12、18、24h比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:對(duì)不穩(wěn)定型心絞痛患者而言,前列地爾和尼可地爾在PCI相關(guān)心肌損傷中具有協(xié)同的心肌保護(hù)作用,比單用其中一種藥物保護(hù)效果好。
[Abstract]:Objective: coronary atherosclerotic heart disease is one of the major diseases threatening the health of all mankind. Percutaneous coronary intervention (PCI) is a commonly used method for revascularization. The purpose of this study was to investigate the protective effects of alprostadil and nicorandil on myocardial injury in patients with unstable angina pectoris undergoing percutaneous coronary intervention. Methods: 120 patients with unstable angina pectoris diagnosed as unstable angina pectoris were randomly divided into 4 groups with 30 cases in each group. After admission, the control group was given routine drug therapy for unstable angina pectoris according to the relevant guidelines, while the prostadil group was given 10 渭 g prostadil intravenously before and after the treatment 48 hours before operation and once a day. In the nicorandil group, nikodil oral preparation was given at the same time as routine drug therapy 48 hours before and after the operation, five mg per day, three times a day. The two drugs were mixed on the basis of routine drug therapy. Alprostadil was given 10 渭 g intravenously at 48 hours before and after operation, once a day and 5 mg / d with Nicorandil orally, three times a day. The serum levels of creatine kinase isoenzyme (CK-MB), hypersensitive C-reactive protein (hs-CRP) and Gao Min troponin T (hs-c T) were observed and compared before and after PCI. Results: there was no significant difference in the general status of the subjects before PCI, the number of coronary artery lesions and the number of stents implanted in the four groups in the control group, alprostadil group, nicordil group and the mixed group of two drugs (P0.05). Myocardial injury markers and hypersensitive C-reactive protein (hs-CRP) in the control group and three treatment groups were higher than those before coronary intervention in the four periods after coronary intervention. The levels of serum creatine kinase isoenzyme (CK-MB), hypersensitive C-reactive protein (hs-CRP) and Gao Min troponin T (hs-c T) in alprostadil group and nicordil group were significantly lower than those in control group at 612 ~ 18h after PCI (P0.05). The serum levels of creatine kinase isoenzyme (CK-MB), hypersensitive C-reactive protein (hs-CRP) and Gao Min troponin T (hs-c T) were significantly lower than those in the control group (P 0.05). The levels of serum creatine kinase isoenzyme (CK-MB), hypersensitive C-reactive protein (hs-CRP) and Gao Min troponin T (hs-c T) in serum of the patients in the two groups were lower than those in the alprostadil group and nicordil group at 24 h after PCI. The difference was statistically significant (P0.05). There was no significant difference in serum creatine kinase isoenzyme (CK-MB), hypersensitive C-reactive protein (hs-CRP) and Gao Min troponin T (hs-c T) between the alprostadil group and nicordil group (P 0.05). Conclusion: prostadil and nicorandil have synergistic myocardial protective effect in patients with unstable angina pectoris, which is better than one drug alone.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.4

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