目的:探讨尼可地尔对老年急性ST段抬高型心肌梗死(STEMI)患者脑钠肽(BNP)水平与冠脉血流情况的影响。方法:选取我院于2013年1月至2015年10月期间收治的80例行急诊经皮冠状动脉介入(PCI)术的STEMI患者,采用简单随机抽样法平均分为两组:观察组围手术期静脉滴注尼可地尔,对照组围手术期静脉滴注同体积生理盐水,观察两组患者术后BNP水平与冠脉血流情况。结果:观察组37例(92.5%)患者术后90 min心电图显示,心电图ST段变化(sumSTR)回落高于50%,对照组32例(80.0%)sumSTR回落高于50%,卡方检验表明差异有统计学意义(χ2=9.89,P=0.00);观察组术后TIMI3级血流和心肌灌注率分别为92.5%和87.5%,显著高于对照组(82.5%,77.5%)(P<0.05);两组患者术后1周和4周时血浆BNP水平较治疗前显著下降(P<0.05),观察组术后1周和4周的血浆BNP水平显著低于对照组(P<0.05);观察组术后1周和4周的LVEF显著高于对照组,差异有统计学意义(P<0.05);两组患者术后1周的LVEF、LVESD及术后4周的LVEF、LVEDD和LVESD之间差异有统计学意义(P<0.05),且观察组术后4周的LVEF和LVEDD显著优于术后1周时水平,差异具有统计学意义(P<0.05)。观察组随访3个月内不良事件率为10.0%,显著低于对照组(20.0%)(P<0.05)。结论:围手术期静脉滴注尼可地尔能够有效改善STEMI患者术后冠脉血流情况,降低血浆BNP水平,避免心功能损伤,降低心脏不良事件发生率,改善预后。 |
Objective:To explore the impact of nicorandil on BNP level and coronary blood flow condition of elderly patients with acute ST segment myocardial infarction(STEMI). Methods:In our hospital during the period from January 2013 to October 2015, 80 STEMI patients treated with routine PCI using simple random sampling were divided into two groups:in observation group intravenous nicorandil was perioperatively administrated, in the control group intravenous saline was perioperatively administrated, postoperative patients' BNP levels and coronary blood flow were observed. Results:90 min ECG sumSTR of 37 cases (92.5%) in the observation group fell more than 50%, sumSTR of 32 patients (80.0%) in the control group fell more than 50%, chi-square test showed significant difference (χ2=9.89, P=0.00); postoperative TIMI3 level observed blood flow and myocardial perfusion rate were 92.5% and 87.5%, respectively, which were significantly higher than those in the control group(82.5%, 77.5%), the differences had statistically significances (P<0.05); one week and four weeks after operation, plasma BNP levels in two groups of patients significantly decreased than those before treatment (P<0.05), and the plasma BNP levels in the observation group were significantly lower than those in the control group, and the LVEF was higher in the observation group (P<0.05); LVEF, LVESD one week after operation had significant differences (P<0.05) between two groups and the LVEF, LVEDD and LVESD four weeks after operation had significant differences between two groups(P<0.05), and LVEF and LVEDD 4 weeks after operation in the observation group were significantly better than those 1 week after operation, the differences were statistically significant (P<0.05). The rate of adverse events within 3 months in the observation group was 10.0%, which was significantly lower than that in the control group (20.0%) (P<0.05). Conclusion:Perioperative use of intravenous nicorandil can improve postoperative coronary blood flow, reduce plasma BNP levels, avoid damage of cardiac function, reduce the incidence of cardiac adverse events, improv prognosis on patients with STEMI. |
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