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尼可地尔对不稳定型心绞痛患者PCI术后血管内皮功能及心绞痛再发作的影响
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| 篇名： | 尼可地尔对不稳定型心绞痛患者PCI术后血管内皮功能及心绞痛再发作的影响 |
| TITLE： | |
| 摘要： | 目的：观察尼可地尔对不稳定型心绞痛患者经皮冠状动脉介入治疗（PCI）术后血管内皮功能及心绞痛再发作的影响。方法：选取2016年1月－2018年3月四川省人民医院（东院）收治的不稳定型心绞痛患者195例，按随机数字表法分为对照组（97例）和观察组（98例）。两组患者均行PCI术，于术后皮下注射依诺肝素钠注射液，并予单硝酸异山梨酯缓释片、阿司匹林肠溶片、硫酸氢氯吡格雷片、阿托伐他汀钙片等基础治疗；观察组患者在对照组治疗的基础上，加服尼可地尔片5 mg，tid。两组患者均连续治疗6个月。观察其手术前后血管内皮功能相关指标[血管扩张功能（FMD）、内皮素1（ET-1）、一氧化氮（NO）]、心肌损伤标志物[心肌肌钙蛋白Ⅰ（cTnⅠ）、肌酸激酶同工酶MB（CK-MB）]和炎症因子[超敏C反应蛋白（hs-CRP）]水平，并记录心绞痛再发作、心血管不良事件（MACE）以及不良反应发生情况。结果：对照组、观察组分别有6、4例患者脱落。术前1天，两组患者血管内皮功能相关指标、心肌损伤标志物、炎症因子水平比较，差异均无统计学意义（P＞0.05）。术后1天，两组患者FMD、NO水平均显著降低，ET-1、cTnⅠ、CK-MB水平均显著升高（P＜0.05）。术后1、6个月，两组患者FMD、NO水平均显著升高，且观察组显著高于对照组；ET-1、cTnⅠ、CK-MB、hs-CRP水平均显著降低，且观察组显著低于对照组（P＜0.05）。观察组患者心绞痛再发作发生率及发作次数、发作持续时间，心绞痛Ⅲ级患者的比例以及MACE总发生率均显著低于、少于或短于对照组（P＜0.05）；两组患者不良反应总发生率比较，差异无统计学意义（P＞0.05）。结论：加用尼可地尔可进一步改善不稳定型心绞痛患者的血管内皮功能，缓解其心肌损伤和炎症反应水平，减少PCI术后心绞痛再发作和MACE的发生，且不影响常规治疗的安全性。 |
| ABSTRACT： | OBJECTIVE： To observe the effects of nicorandil on vascular endothelial function and angina pectoris recurrence in patients with unstable angina pectoris after percutaneous coronary intervention （PCI）. METHODS： Totally 195 patients with unstable angina pectoris were collected from Sichuan Provincial People’s Hospital during Jan. 2016-Mar. 2018， and then divided into control group （97 cases） and observation group （98 cases） according to random number table. Both groups received PCI， and then given basic treatment as Enoxaparin sodium injection， Isosorbide mononitrate sustained-release tablets， Aspirin enteric-coated tablets， Clopidogrel sulfate tablets and Atorvastatin calcium tablets after PCI. Observation group additional received Nicorandil tablet 5 mg， tid， on the basis of control group. Both groups were treated for 6 months. The levels of vascular endothelial function related indexes （FMD， ET-1， NO）， myocardial injury markers （cTnⅠ， CK-MB） and inflammatory factors （hs-CRP） were observed before and after PCI. The recurrent angina pectoris， the occurrence of MACE and ADR were recorded. RESULTS： 6 patients of control group and 4 patients of observation group withdrew from the study. One day before operation， there was no significant difference in the levels of vascular endothelial function， myocardial injury markers or inflammatory factors between 2 groups （P＞0.05）. One day after operation， the levels of FMD and NO in both groups decreased significantly， while the levels of ET-1， cTnⅠ and CK-MB increased significantly （P＜0.05）. The levels of FMD and NO were increased significantly in the 1st and 6th months after surgery， and the observation group was significantly higher than the control group； the levels of ET-1， cTnⅠ， CK-MB and hs-CRP were decreased significantly， and the observation group was significantly lower than the control group （P＜0.05）. The incidence and times of recurrent angina pectoris， duration， the proportion of grade Ⅲ angina pectoris and total incidence of MACE in observation group were significantly lower， less or shorter than control group （P＜0.05）. There was no statistical significance in total incidence of ADR between 2 groups （P＞0.05）. CONCLUSIONS： Additional use of nicorandil can improve vascular endothelial function， relieve the myocardial injury and inflammatory response， reduce the occurrence of recurrent angina pectoris and MACE after PCI and doesn’t influence the safety of routine treatment. |
| 期刊： | 2019年第30卷第8期 |
| 作者： | 李明，赵鸿彦，张亚玲，赖金川 |
| AUTHORS： | LI Ming，ZHAO Hongyan，ZHANG Yaling，LAI Jinchuan |
| 关键字： | 尼可地尔；经皮冠状动脉介入治疗；不稳定型心绞痛；血管内皮功能；心肌损伤；炎症因子；心绞痛再发作 |
| KEYWORDS： | Nicorandil； Percutaneous coronary intervention； Unstable angina pectoris； Vascular endothelial function； Myocardial injury； Inflammation factor； Recurrent angina pectoris |
| 阅读数： | 488 次 |
| 本月下载数： | 3 次 |
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