天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (11): 1153-1157.doi: 10.11958/20170799

• 专题-心肌梗死 • 上一篇    下一篇

尼可地尔对急性非ST段抬高型心肌梗死PCI术中慢血流的疗效观察

黎文婷，姚朱华，庞志华，蔡洪滨，程立松，曹明英，宋敏   

  1. 1 天津中医药大学研究生院（邮编 300193）；2 天津市人民医院心内科；3 唐山市工人医院
  • 收稿日期:2017-07-10 修回日期:2017-09-21 出版日期:2017-11-15 发布日期:2017-11-15
  • 通讯作者: 黎文婷 E-mail:1510473773@qq.com

The effect of nicorandil on slow-flow phenomenon in PCI in patients with non-ST segment elevated myocardial infarction#br#

LI Wen-ting,YAO Zhu-hua,PANG Zhi-hua,CAI Hong-bin,CHENG Li-song,CAO Ming-ying,SONG Min   

  1. 1 Postgraduate School of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China;2 Department of Cardiology, Tianjin Union Medical Center; 3 Tangshan Gongren Hospital
  • Received:2017-07-10 Revised:2017-09-21 Published:2017-11-15 Online:2017-11-15

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摘要： 目的 观察冠脉内注射尼可地尔对于改善急性非 ST 段抬高型心肌梗死（NSTEMI）经皮冠状动脉介入治疗术（PCI）术中慢血流/无复流的情况。方法 选取急性非 ST 段抬高型心肌梗死（NSTEMI）患者 159 例，根据 PCI 术后靶病变血管 TIMI 血流分为 2 组，TIMI≤2 级为慢血流/无复流组（31 例）,TIMI 血流 3 级为复流正常（reflow）组（128例）。比较 2 组患者的一般临床资料、PCI 治疗后梗死相关血管（IRA）的 TIMI 血流分级、校正的 TIMI 血流计帧数（CTFC）和 TIMI 心肌灌注分级、血栓征象、病变血管数目及主要心脏不良事件（MACE）发生情况。给予慢血流/无复流组的患者冠脉内注射尼可地尔，观察用药前后血流改善情况。慢血流/无复流的影响因素采用多因素 Logistic 回归分析。结果 慢血流/无复流组吸烟史、糖尿病史、患高脂血症、术中发生低血压、多支架（≥3 个）及术后使用替罗非班者的比例，CTFC、有血栓征象的比例明显高于复流正常组患者（P＜0.05）；2 组患者术中心率、IRA 分布、病变血管支数差异无统计学意义。2 组 MACE 发生率、术后 7 d 左室射血分数差异无统计学意义；慢血流/无复流组应用尼可
地尔后，患者 TIMI 血流 3 级比例，术后 cTFC、TMPG 3 级比例均明显高于应用尼可地尔前（P＜0.05）。有吸烟史、糖尿病病史、多支架（≥3 个）、术中低血压、血栓征象是冠脉发生慢血流/无复流的危险因素。结论 尼可地尔可显著改善 NSTEMI 患者 PCI 术中慢血流/无复流。

关键词: 尼可地尔, 心肌再灌注损伤, 非 ST 段抬高型心肌梗死, 经皮冠脉介入治疗, 慢血流/无复流

Abstract: Objective To observe the effect of nicorandil on slow-flow phenomenon in percutaneous coronary intervention (PCI) in patients with acute non-ST segment elevated myocardial infarction (NSTEMI). Methods A total of 159 NSTEMI patients were enrolled. Based on the TIMI flow of target lesion blood vessels after PCI, patients were divided into two groups. There were 31 cases in no flow/slow flow group (TIMI≤2), and 128 cases in normal group (TIMI=3). The general clinical data, immediate TIMI flow grade of infarct-related artery (IRA) after PCI treatment, post-operative corrected TIMI frame count (CTFC), TIMI myocardial perfusion grade (TMPG), thrombolysis in myocardial infarction signs of a blood clot, number of diseased vessels and major adverse cardiac events were compared between the two groups. The patients in no flow / slow flow group were given nicorandil, and changes of blood flow before and after treatment were observed. The influence factors of no flow/slow flow were analyzed by multifactor Logistic regression. Results The proportions of patients with history of smoking, the proportion of patients with diabetes history, the proportion of patients with hyperlipidemia, the proportion of patients with low blood pressure in operation, and the number of implanted stents, the proportions of patients took tirofiban in operation, post-operative CTFC, the proportions of patients with thrombosis signs were significantly higher in no flow/slow flow group than those in the normal group (P＜0.05). There were no significant differences in heart rates in operation, IRA distribution and the number of lesion vessels between the two groups. There were also no significant differences in the incidence of MACE and left ventricular ejection fraction between the two groups. After the application of nicorandil, the proportion of patients with TIMI blood flow 3 and proportions of cTFC and TMPG were significantly higher than before treatment (P＜0.05). Results showed that smoking history, history of diabetes, multiple stents (more than 3),hypotension in PCI, and signs of blood clot were factors influencing the slow flow of coronary arteries. Conclusion
Nicorandil can significantly improve the no flow/slow flow in PCI in patients with NSTEMI.

Key words: Nicorandil, myocardial reperfusion injury, non-ST segment elevated myocardial infarction, percutaneous coronary intervention, no flow/slow flow

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