疑难病杂志
疑難病雜誌
의난병잡지
JOURNAL OF DIFFICULT AND COMPLICATED CASES
2015年
1期
16-19
,共4页
韩红彦%贾海珍%周琦%马丽
韓紅彥%賈海珍%週琦%馬麗
한홍언%가해진%주기%마려
心绞痛,不稳定型%尼可地尔%经皮冠状动脉介入治疗%缺血预适应
心絞痛,不穩定型%尼可地爾%經皮冠狀動脈介入治療%缺血預適應
심교통,불은정형%니가지이%경피관상동맥개입치료%결혈예괄응
Angina pectoris,unstable%Nicorandil%Percutaneous coronary intervention%Ischemic preconditioning
目的：探讨尼可地尔对不稳定型心绞痛患者介入治疗的心肌保护作用。方法选取不稳定型心绞痛患者共94例，随机分为观察组45例和对照组49例，观察组在PCI术前（5±2）d开始服用尼可地尔5 mg，3次／d；术前2 h顿服10 mg，术后继续给予5 mg，每天3次，服用4周；对照组不服用尼可地尔，其他治疗相同；观察PCI术中心绞痛发作及心电图变化；检测PCI术前、术后6 h及24 h的肌钙蛋白I（cTnI）和磷酸肌酸激酶同工酶（CK-MB）浓度；多普勒超声观察PCI术前及术后1周、4周心脏功能改善情况。结果观察组PCI术中心绞痛发生5例（112.1％），低于对照组16例（32.7％）（χ2=6.863， P =0.012）；术中球囊扩张时观察组缺血性心电图改变的发生率低于对照组（46.7％vs.65.3％，χ2=5.257， P =0.037）；ST段下降幅度分别为（0.03±0.04）mV和（0.05±0.05）mV，差异有统计学意义（ t =5.257， P =0.037）。术后6 h和24 h肌钙蛋白I浓度明显低于对照组[治疗组（0.032±0.056） U／L、（0.059±0.071）U／L，对照组（0.134±0.193）U／L、（0.366±0.210）U／L， t =2.035， P =0.044；t =8.365， P =0.001]；PCI术后4周观察组左室射血分数值高于对照组[（67.5±6.8）％ vs.（64.1±8.1）％， t =2.194， P =0.031]。结论尼可地尔可以减少PCI术中心绞痛发作和缺血改变，减轻心肌损伤，长期服用可进一步改善患者的左心功能。
目的：探討尼可地爾對不穩定型心絞痛患者介入治療的心肌保護作用。方法選取不穩定型心絞痛患者共94例，隨機分為觀察組45例和對照組49例，觀察組在PCI術前（5±2）d開始服用尼可地爾5 mg，3次／d；術前2 h頓服10 mg，術後繼續給予5 mg，每天3次，服用4週；對照組不服用尼可地爾，其他治療相同；觀察PCI術中心絞痛髮作及心電圖變化；檢測PCI術前、術後6 h及24 h的肌鈣蛋白I（cTnI）和燐痠肌痠激酶同工酶（CK-MB）濃度；多普勒超聲觀察PCI術前及術後1週、4週心髒功能改善情況。結果觀察組PCI術中心絞痛髮生5例（112.1％），低于對照組16例（32.7％）（χ2=6.863， P =0.012）；術中毬囊擴張時觀察組缺血性心電圖改變的髮生率低于對照組（46.7％vs.65.3％，χ2=5.257， P =0.037）；ST段下降幅度分彆為（0.03±0.04）mV和（0.05±0.05）mV，差異有統計學意義（ t =5.257， P =0.037）。術後6 h和24 h肌鈣蛋白I濃度明顯低于對照組[治療組（0.032±0.056） U／L、（0.059±0.071）U／L，對照組（0.134±0.193）U／L、（0.366±0.210）U／L， t =2.035， P =0.044；t =8.365， P =0.001]；PCI術後4週觀察組左室射血分數值高于對照組[（67.5±6.8）％ vs.（64.1±8.1）％， t =2.194， P =0.031]。結論尼可地爾可以減少PCI術中心絞痛髮作和缺血改變，減輕心肌損傷，長期服用可進一步改善患者的左心功能。
목적：탐토니가지이대불은정형심교통환자개입치료적심기보호작용。방법선취불은정형심교통환자공94례，수궤분위관찰조45례화대조조49례，관찰조재PCI술전（5±2）d개시복용니가지이5 mg，3차／d；술전2 h돈복10 mg，술후계속급여5 mg，매천3차，복용4주；대조조불복용니가지이，기타치료상동；관찰PCI술중심교통발작급심전도변화；검측PCI술전、술후6 h급24 h적기개단백I（cTnI）화린산기산격매동공매（CK-MB）농도；다보륵초성관찰PCI술전급술후1주、4주심장공능개선정황。결과관찰조PCI술중심교통발생5례（112.1％），저우대조조16례（32.7％）（χ2=6.863， P =0.012）；술중구낭확장시관찰조결혈성심전도개변적발생솔저우대조조（46.7％vs.65.3％，χ2=5.257， P =0.037）；ST단하강폭도분별위（0.03±0.04）mV화（0.05±0.05）mV，차이유통계학의의（ t =5.257， P =0.037）。술후6 h화24 h기개단백I농도명현저우대조조[치료조（0.032±0.056） U／L、（0.059±0.071）U／L，대조조（0.134±0.193）U／L、（0.366±0.210）U／L， t =2.035， P =0.044；t =8.365， P =0.001]；PCI술후4주관찰조좌실사혈분수치고우대조조[（67.5±6.8）％ vs.（64.1±8.1）％， t =2.194， P =0.031]。결론니가지이가이감소PCI술중심교통발작화결혈개변，감경심기손상，장기복용가진일보개선환자적좌심공능。
Objective To investigate the protective effects of nicorandil on myocardial in patients with unstable angi -na pectoris after interventional therapy .Methods Selected patients with unstable angina of 94 cases, they were randomly di-vided into observation group with 45 cases and control group with 49 cases, the observation group started taking nicorandil 5 mg (5 ±2) days before PCI, 3 times a day;2 h before the operation took 10 mg, the postoperative continuing to give 5 mg, 3 times /day, lasted for 4 weeks;the control group did not treat with nicorandil , other treatment were the same;angina and ECG changes during PCI were observed; cardiac troponin I ( cTnI) and creatine kinase isoenzyme ( CK-MB) concentration before PCI, 6 h and 24 h after PCI were detected; heart function improvement preoperatively and 1 week, 4 week after PCI were evaluated.Results Angina occurred of 5 cases in the observation group during PCI patients (11.1%), which is lower than that of the control group of 16 cases (32.7%) (χ2 =6.863, P =0.012);during balloon dilatation, the ischemic ECG changes occurred in observation group was lower than the control group (46.7% vs.65.3%,χ2 =5.257, P =0.034); ST segment decline were (0.03 ±0.04) mV and (0.05 ±0.05) mV, the difference was statistically significant ( t =5.257, P =0.037).6 h and 24 h after PCI's CTnI concentration were significantly lower than those in control group , respectively (0.032 ±0.056) U/L, (0.059 ±0.071) U/L in observation group and (0.134 ±0.193) U/L, (0.366 ±0.210) U/L in control group( t =2.035, P =0.044;t =8.365, P =0.001) ;4 weeks after PCI, the observation group's left ventricular ejection fraction values were higher than that of the control group [(67.5 ±6.8)% vs.(64.1 ±8.1)% respectively, t =2.194, P =0.031].Conclusion Nicorandil can release the symptoms of angina and ischemic during PCI , reduce myocardi-al injury and improve left ventricular function in patients with long-term usage.
