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目的:探讨尼可地尔是否能通过模拟缺血后适应效应来减少急性前壁ST段抬高心肌梗死患者的心肌梗死面积。方法:急性前壁心肌梗死的患者随机分为两组,尼可地尔组(NIC组,21例)及消心痛组(ISDN组,22例)。NIC组患者在行PCI术前服用10mg尼可地尔,而ISDN组服用10mg硝酸异山梨酯。2组患者均在PCI前及PCI后8、16、24、48、72h测定血清肌酸激酶同工酶(CK-MB)浓度,术后7d行ECT心肌灌注显像。结果:尼可地尔能显著减少心肌梗死后的CK-MB峰值[NIC组(171.6±105.7)U/L,ISDN组(246.4±108.4)U/L,P<0.05],并能减少CK-MB曲线下面积[NIC组(4 309±2 575),ISDN组(5 854±2 352),P<0.05],改善ECT心肌灌注缺损面积占左室的百分比[NIC组(30.38±11.83)%,ISDN组(38.64±14.59)%,P<0.05],且NIC组ECT心肌灌注缺损评分优于ISDN组[NIC组(25.19±11.96),ISDN组(33.27±14.03),P<0.05]。结论:尼可地尔可以通过激活心肌细胞线粒体K-ATP通道,模拟药物后适应效应,从而减少心肌梗死面积。
PURPOSE: To investigate whether nicorandil reduces myocardial infarct size in patients with acute ST-segment elevation myocardial infarction by simulating post-ischemic adaptation. Methods: Patients with acute anterior myocardial infarction were randomly divided into two groups: Nicorandil group (NIC group, n = 21) and antithrombotic group (ISDN group, n = 22). Patients in the NIC group took nicorandil 10 mg prior to PCI and ISDN 10 mg isosorbide dinitrate. Serum CK-MB concentrations were measured in both groups before PCI and at 8, 16, 24, 48 and 72 h after PCI. ECT myocardial perfusion imaging was performed at 7 days after operation. RESULTS: Nicorandil significantly reduced the peak of CK-MB after myocardial infarction (NIC group (171.6 ± 105.7) U / L, ISDN group (246.4 ± 108.4) U / L, P <0.05] The area under the MB curve [NIC group (4 309 ± 2 575), ISDN group (5 854 ± 2 352), P <0.05] improved the percentage of left ventricular area of myocardial perfusion defects [30.38 ± 11.83% , ISDN group (38.64 ± 14.59)%, P <0.05]. The score of ECT in NIC group was superior to ISDN group [25.19 ± 11.96 in NIC group and 33.27 ± 14.03 in ISDN group, P <0.05]. Conclusion: Nicorandil can reduce the area of myocardial infarction by activating mitochondrial K-ATP channels in cardiac myocytes and simulating the post-drug adaptation effect.