[尼可地尔对接受急诊经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者室性心律失常的影响]

[Effect of nicorandil on ventricular arrhythmia in patients with acute ST-segment elevation myocardial infarction underwent emergent percutaneous coronary intervention treatment].

作者信息

Wang Y P, Zhang Y, Sun Y R, Sun Z G, Zuo Z K, Feng Z R, Chang F Y, Xu Y C, Chen B Z, Ye Y Y

机构信息

Department of Cardiology, Second People's Hospital of Liaocheng, Liaocheng 252600, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2017 Aug 24;45(8):701-705. doi: 10.3760/cma.j.issn.0253-3758.2017.08.016.

DOI:10.3760/cma.j.issn.0253-3758.2017.08.016

PMID:28851188

Abstract

To investigate the effect of nicorandil on ventricular arrhythmia in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with emergent percutaneous coronary intervention (PCI). A total of 120 acute STEMI patients treated with emergent PCI in our hospital from January 2015 to June 2016 were randomly divided into control group and experiment group (=60 each). Patients in both groups received conventional therapy.Patients in experiment group took 10 mg nicorandil orally before PCI and received oral nicorandil treatment (15 mg/d, three times daily) for 3 days.QT disperse(QTd), correct QTd(QTcd) and the occurrence rate of ventricular arrhythmia were compared between two groups. QTd at 6, 24, 48 and 72 hours((70.6±4.4), (67.2±5.3), (55.7±8.5), (48.2±8.2) ms, respectively) after PCI was significantly lower in the experiment group than those of control group ((77.1±7.1), (71.3±6.5), (65.1±8.1), (57.2±5.4) ms, all <0.05). The level of QTd was also significantly lower in the experiment group at 6, 24, 48 and 72 hours((77.5±7.7), (67.7±8.6), (61.2±7.5), (52.9±8.4) ms, respectively) after PCI comared to those of control group ((88.6±8.1), (79.2±7.8), (74.4±7.4), (69.6±8.6) ms, all <0.05). There was no significant difference in the incidence of reperfusion arrhythmia during PCI procedure between the two groups.The prevalence of the ventricular premature beat in the experiment group (25/60, 41.7%) was significantly lower than in the control group(45/60, 75.0%) within 3 days after PCI(<0.01), the prevalence of the no sustained ventricular tachycardia and ventricular fibrillation in the experiment group(6/60, 10.0%) was also significantly lower than in the control group (18/60, 30.0%, <0.01) within 3 days after PCI. Nicorandil use prior and post PCI could decrease the occurrence rate of ventricular arrhythmia in STEMI patients undergoing emergent PCI, and this effect might be related with reduced QTd and QTcd post medication.

摘要

探讨尼可地尔对接受急诊经皮冠状动脉介入治疗（PCI）的急性ST段抬高型心肌梗死（STEMI）患者室性心律失常的影响。选取2015年1月至2016年6月在我院接受急诊PCI治疗的120例急性STEMI患者，随机分为对照组和试验组（每组60例）。两组患者均接受常规治疗。试验组患者在PCI术前口服10 mg尼可地尔，并接受口服尼可地尔治疗（15 mg/d，每日3次），共3天。比较两组患者的QT离散度（QTd）、校正QT离散度（QTcd）及室性心律失常发生率。试验组PCI术后6、24、48及72小时的QTd（分别为(70.6±4.4)、(67.2±5.3)、(55.7±8.5)、(48.2±8.2) ms）显著低于对照组（(77.1±7.1)、(71.3±6.5)、(65.1±8.1)、(57.2±5.4) ms，均P<0.05）。试验组PCI术后6、24、48及72小时的QTd水平（分别为(77.5±7.7)、(67.7±8.6)、(61.2±7.5)、(52.9±8.4) ms）也显著低于对照组（(88.6±8.1)、(79.2±7.8)、(74.4±7.4)、(69.6±8.6) ms，均P<0.05）。两组患者PCI术中再灌注心律失常发生率无显著差异。试验组PCI术后3天内室性早搏发生率（25/60，41.7%）显著低于对照组（45/60，75.0%，P<0.01），试验组PCI术后3天内非持续性室性心动过速和心室颤动发生率（6/60，10.0%）也显著低于对照组（18/60，30.0%，P<0.01）。PCI术前及术后使用尼可地尔可降低接受急诊PCI的STEMI患者室性心律失常的发生率，且这种作用可能与用药后QTd和QTcd降低有关。