摘要
目的:分析探讨冠脉内注射尼可地尔对NSTEMI患者经皮冠状动脉介入治疗术中慢血流/无复流的影响及危险因素.方法:选取我院于2016年6月至2018年6月期间收治的110例急性非ST段抬高型心肌梗死(Non-st-segment elevation myocardial infarction,NSTEMI)患者,根据患者进行经皮冠状动脉介入治疗术后的靶病变血管TIMI分流情况将其划分为对照组和试验组两组,其中TIMI不超过2级的患者,即慢血流/无复流患者划分为试验组,共25例;而TIMI为3级的患者,即复流正常的患者划分为对照组,共85例.记录两组患者的一般资料,观察两组患者的冠脉介入手术的相关指标,比较两组患者住院期间主要心脏不良事件的发生情况,分析试验组患者应用尼可地尔前后的血流指标,对影响患者介入术中慢血流/无复流的相关因素进行Logistic回归分析.结果:试验组患者中具有高脂血症、糖尿病史、吸烟史等患者比例均显著高于对照组患者(χ^2=5.938,χ^2=4.857,χ^2=4.585,均P<0.05).两组患者的术中心率并无明显差异(t=0.241,P>0.05);试验组患者的血栓征象和使用替罗非班、多支架、CTFC、术中低血压发生率等均显著高于对照组患者(χ^2=8.273,χ^2=6.394,χ^2=6.028,t=22.349,χ^2=5.273,均P<0.05).试验组在住院期间有1例患者因为出现心源性休克而死亡,两组患者均无再发心肌梗死者并且两组患者的主要心脏不良事件发生率并无明显差异(均P>0.05).经过尼可地尔治疗后试验组患者的TMPG3级和TIMI血流3级比例均显著高于本组治疗前(χ^2=47.232,χ^2=53.234,均P<0.05);经过尼可地尔治疗后试验组患者的CTFC显著低于本组治疗前(t=8.273,P<0.05).血栓征象、多支架、术中低血压、糖尿病史、吸烟史等均是影响患者出现慢血流/无复流的危险因素(均P<0.05).结论:PCI术中血栓、低血压征象以及多支架、糖尿病病史、吸烟史等均是影响患者冠脉发生慢血流/无复流的相关危险因素,对于NSTEMI患者采用冠脉内注射尼可地尔治疗能够有效改善其PCI术中慢血流/无复流的情况.
Objective: To investigate the effect and risk factors of intracoronary injection of nicorandil on slow flow / no reflow during percutaneous coronary intervention in patients with NSTEMI. Methods: 110 patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) admitted to our hospital from June 2016 to June 2018 were divided into control group and experimental group according to TIMI shunt of target lesions after percutaneous coronary intervention. Among them, patients with TIMI no more than grade 2, i.e. slow flow/no reflow, were divided into experimental group (25 cases), while patients with TIMI grade 3, i.e. patients with normal reflow, were divided into control group (85 cases). The general data of two groups of patients were recorded, and the related indicators of coronary interventional surgery in two groups were observed, the occurrence of major adverse cardiac events in two groups during hospitalization were compared, and the blood flow indicators before and after the application of nicorandil in the experimental group were analyzed. Logistic regression analysis was used to analyze the related factors affecting slow/no-reflow flow during interventional procedures. Results: The proportion of patients with hyperlipidemia, diabetes history, smoking history, etc. in the experimental group was significantly higher than that of the control group (P<0.05). There was no significant difference in the intraoperative center rate between the two groups (t=0.241, P>0.05). The thrombus signs and incidence of intraoperative hypotension in the experimental group were significantly higher than those in the control group (χ^2=8.273,χ^2=6.394,χ^2=6.028, t=22.349,χ^2=5.273, all P<0.05). During the hospitalization period, 1 patient in the experimental group died due to cardiogenic shock, and there was no recurrence of myocardial infarction in both groups and no significant difference in the incidence of major cardiac adverse events in the two groups (all P>0.05). The ratio of TMPG3 level and TIMI blood flow level 3 in the experimental group was significantly higher than that before the treatment in this group (χ^2=47.232,χ^2=53.234, P<0.05). After treatment with nicorandil, CTFC of the experimental group was significantly lower than that of this group (t=8.273, P<0.05). Thrombosis, multiple stents, intraoperative hypotension, diabetes history, and smoking history were all risk factors for slow blood flow/no complex flow (all P<0.05). Conclusion: Thrombosis, signs of hypotension, multiple stents, history of diabetes mellitus and smoking during PCI are all related risk factors affecting the occurrence of slow/no-reflow coronary flow in patients with NSTEMI. Intracoronary nicorandil injection can effectively improve slow/no-reflow coronary flow in patients with NSTEMI.
作者
宋长来
付新
孙江涛
SONG Changlai;FU Xin;SUN Jiangtao(The First Affiliated Hospital of Xinjiang Medical University, Changji Branch, Xinjiang Changji 831100, China)
出处
《河北医学》
CAS
2019年第8期1249-1253,共5页
Hebei Medicine
基金
新疆维吾尔自治区自然科学基金资助项目,(编号:2014-211C077)
关键词
心肌再灌注损伤
尼可地尔
心肌梗死
慢血流/无复流
介入治疗
Myocardial reperfusion injury
Nicorandil
Myocardial infarction
Slow blood flow / no reflow
Interventional therapy
