目的 观察尼可地尔(nicorandil,NCR)治疗非ST抬高型急性冠脉综合征的疗效及不良反应。方法 选取医院2017-10至2019-01收治的170例非ST抬高型急性冠脉综合征患者,随机分为硝酸甘油组(n=86)和NCR组(n=84),在抗血小板、调脂等常规治疗基础上,硝酸甘油组静脉滴注硝酸甘油25 mg/d,NCR组静脉滴注NCR 12 mg/d,连续治疗7 d。观察两组临床疗效及不良反应发生率。随访3~6个月,观察复发率。结果 治疗1周后,NCR组心绞痛发作频率与 ST 段压低幅度均较入院前明显缓解。治疗有效率为97.6%,显效50例,有效32例,无效2例。硝酸甘油组治疗有效率为73.3%,显效17例,有效46例,无效23例。不良反应发生率:NCR组为56.0%,硝酸甘油组为86.0%,两组比较差异有统计学意义(P<0.05)。随访3～6个月,NCR组仅2例复发心绞痛,硝酸甘油组16例复发心绞痛,差异有统计学意义(P<0.05)。结论 NCR治疗非ST抬高型急性冠脉综合征具有较好的临床疗效,不良反应少,复发率较低。
Abstract
Objective To investigate the efficacy and adverse reactions of nicorandil in the treatment of non-ST elevation acute coronary syndrome.Methods A total of 170 patients with non-ST-elevation acute coronary syndrome were treated with nitroglycerin and nicorandil respectively between October 2017 and January 2019. In addition to routine treatment such as antiplatelet and lipid regulation, 86 patients in the nitroglycerin group were treated with 25 mg nitroglycerin while another 84 patients in the nicorandil group were treated with 12 mg nicorandil. The clinical efficacy and incidence of adverse reactions were compared between the two groups.Results After one week of treatment, the frequency of angina attack and ST segment depression in the nicorandil group were significantly alleviated. The effective rate of treatment was 97.6%. The treatment was markedly effective in 50 cases, effective in 32 cases but ineffective in 2 cases. In the nitroglycerin group, the effective rate was 73.3%, as the treatment was markedly effective in 17 cases, effective in 23 cases and ineffective in 46 cases. The incidence of adverse reactions was 56.0% in the nicorandil group and 86.0% in the nitroglycerin group (P< 0.05). All the patients were followed up for 3 to 6 months. There was no recurrence of angina pectoris in the nicorandil group, but angina pectoris recurred in 30 patients in the nitroglycerin group within 2 to 4 months after treatment, which was improved after readmission.Conclusions NCR has a good clinical effect in the treatment of non-ST elevation acute coronary syndrome with fewer adverse reactions.
关键词
尼可地尔 /
心绞痛 /
疗效 /
不良反应
Key words
nicorandil /
angina pectoris /
effect /
adverse reactions
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 周 俊,李东泽,杨毅宁.尼可地尔治疗稳定型心绞痛有效性和安全性的临床研究[J].心血管康复医学杂志,2013,22( 4) : 384-387.
[2] 李悦玮,孙景辉,张文琪,等.尼克地尔后处理对心肌缺血/再灌注损伤的保护作用[J].临床儿科杂志,2013,31( 2) : 182-185.
[3] Tarkin J M,Kaski J C. Vasodilator therapy: nitrates and nicorandil[J].Cardiovasc Drugs Ther, 2016,30(4): 367-378.
[4] 中华医学会心血管病学分会.中华心血管病杂志编辑委员会.非ST段抬高急性冠状动脉综合征诊断和治疗指南(2016)[J].中华心血管病杂志,2017,45(5):359-376.
[5] Amsterdam E A,Wenger N K,Brindis R G,et al.2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes:executive summary[J].J Am Cardiol,2014,64(24):2645-2687.
[6] Miura T,Miura T,Miki T.ATP- sensitive K+ channel openers: old drugs with new clinical benefits for the heart[J].Curr Vasc Pharmacol,2003,1(3):251-258.
[7] Mohler E R,Hiatt W R,Olin J W,et al. Treatment of intermittent claudication with beraprost sodium,an orally active prostaglandin 12 analogue: a double-blinded,randomized,controlled trial[J].J Am Coll Cardiol,2003,41(10):1679-1686.
[8] Task F M,Montalescot G,Sechtem U,et al.2013 ESC guidelines on the management of stable coronary artery disease of the european society of cardiology[J].Eur Heart J,2013,34(38):2940-3003.
[9] Tarkin J M, Kaski J C. Vasodilator therapy: nitrates and nicorandil[J].Cardiovasc Drugs Ther,2016,30(4): 367-378.
[10] Lanza G A,Parrinello R,Figliozzi S. Management of microvascular angina pectoris[J]. Am J Cardiovasc Drugs,2014,14(1): 31-40.
[11] Kostic J,Djordjevicn D A,Dobric M,et al. The effects of nicorandil on microvascular function in patients with ST segment elevation myocardial infarction undergoing primary PCI[J].Cardiovasc Ultrasound, 2015,13: 26.
[12] 贺学魁,董 静,赵 运,等.尼可地尔对心脏X综合征的疗效及对血管内皮功能的影响[J].中国循环杂志,2017,32(7):676-679.
[13] 修泽波,刘兴同,霍学震,等.冠状动脉内应用硝酸甘油和尼可地尔对其血流缓慢的效果[J].青岛大学医学院学报,2017,53(5):575-579.
[14] 王 喆,宋德明,郑元喜,等.冠状动脉慢血流治疗的研究进展[J].安徽医药,2017,21(9):1566-1569.
[15] Nawa T,Nishigaki K,Kinomura Y,et al.Continuous intrave-nous infusion of nicorandil for 4 hours before and 24 hours after percutaneous coronary intervention protects against contrast in duced nephropathy in patients with poor renal function[J].Int J Cardiol,2015,195(15): 228-234.
[16] 孟 斌,王 胜.大剂量瑞舒伐他汀联合疏血通注射液对不稳定型心绞痛患者血清HIF-1α、sCD40L水平变化的影响[J].武警医学,2018,29(6):620-623.
PDF(561 KB)
