李海沛 辛兆阳 褚现明 李天东

[摘要] 目的 观察尼可地尔联合体外反搏对心脏介入治疗（PCI）术后心绞痛的效果。方法 PCI术后心绞痛病人90例，随机分成A、B、C 3组，每组30例。A组给予常规药物治疗;B组在A组基础上给予增强型体外反搏（EECP）治疗，每天1次，每次1 h;C组在B组的基础上给予尼可地尔12 mg+生理盐水50 mL静脉泵入，2 mg/h，每天1次;7 d为1疗程。1个疗程后，观察各组心电图变化、心绞痛发作次数及持续时间、动态心电图心肌缺血总负荷（TIB）及高敏肌钙蛋白T（hs-cTnT）的水平。结果 与治疗前相比，治疗后3组心电图明显改善，心绞痛发作次数减少、持续时间缩短，TIB和hs-cTnT降低，差异均有显著性（Hc=6.12，Z=2.12～2.45，t=13.70～122.28，P<0.05）。治疗前后各指标差值比较，C组、B组大于A组，C组大于B组（F=5.61～827.59，P<0.05）。3组病人均未出现不良反应。结论 静脉应用尼可地尔联合EECP对PCI术后心绞痛有良好的治疗效果，且安全性好。

[关键词] 尼可地尔;反搏动术;心绞痛;治疗结果

[中图分类号] R541.42  [文献标志码] A  [文章編号] 2096-5532（2020）02-0221-04

doi：10.11712/jms.2096-5532.2020.56.048 [开放科学（资源服务）标识码（OSID）]

[网络出版] http：//kns.cnki.net/kcms/detail/37.1517.r.20200325.1004.001.html;2020-03-026 13：58

[ABSTRACT] Objective To observe the efficacy of intravenous nicorandil combined with enhanced external counterpulsa-tion （EECP） for angina after percutaneous coronary intervention （PCI）.  Methods Ninety patients with angina after PCI were randomly divided into groups A， B， and C， with 30 cases in each group. Group A was treated with conventional drugs; group B received 1-hour EECP once daily in addition to the treatment for group A; group C was intravenously given nicorandil 12 mg with 50 mL normal saline pumped at 2 mg/h once daily in addition to the treatment for group B; 7 d constituted a course of treatment. After one treatment course， we recorded the electrocardiogram changes， the frequency and duration of anginal attacks， total ischemia burden （TIB） by ambulatory electrocardiography， and the level of high-sensitivity cardiac troponin T （hs-cTnT）. Results After treatment， all the three groups showed significantly improved electrocardiogram results， significantly decreased frequency and duration of anginal attacks， and significantly reduced TIB and hs-cTnT levels （Hc=6.12，Z=2.12-2.45，t=13.70-122.28，P<0.05）. Groups B and C showed significantly greater changes in those indicators than group A， and group C exhibited significantly greater changes than group B （F=5.61-827.59，P<0.05）. No side effects occurred in any group.  Conclusion Intravenous nicorandil combined with EECP shows good efficacy and safety in patients with angina after PCI.

[KEY WORDS] nicorandil; counterpulsation; angina pectoris; treatment outcome

经皮冠状动脉介入治疗（PCI）技术的不断完善显著降低了心血管事件的发生率，提高了病人生存率及生活质量。但是，仍有部分病人由于存在冠状动脉残余狭窄、侧支循环不良或微循环障碍等，而在PCI术后再发心绞痛[1]。国内外针对此情况主要采取强化抗血小板、抗凝、调脂、改善心肌代谢等方法治疗[2]。增强型体外反搏（EECP）在稳定性心绞痛的治疗中具有确切的临床效果，而冠状动脉内注射尼可地尔在PCI术后无复流或慢血流的治疗中取得了良好效果[4]。本研究观察尼可地尔静脉注射联合EECP 治疗PCI术后再发心绞痛的临床效果及安全性。现将结果报告如下。

1 资料与方法

1.1 一般资料

2018年1月—2019年8月，青岛大学附属心血管病医院收治心绞痛住院病人90例，男44例，女46例;年龄47～83岁，平均（64.0±6.5）岁。……