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首页> 中文期刊> 《中国循证心血管医学杂志》 >尼可地尔对高龄老年冠状动脉多支病变合并心绞痛发作及心功能不全患者的临床疗效

尼可地尔对高龄老年冠状动脉多支病变合并心绞痛发作及心功能不全患者的临床疗效

         
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目的 观察尼可地尔对高龄老年冠状动脉(冠脉)多支病变合并心绞痛及心功能不全患者的临床疗效.方法 选择2016年1月至2019年1月于解放军总医院第七医学中心老年心血管科住院的高龄冠脉多支病变合并心绞痛及心功能不全的患者131例,随机分为2组,其中对照组65例,观察组66例.对照组患者给予常规心绞痛及心功能不全的综合治疗措施,观察组在常规治疗基础上,给予尼可地尔5 mg 2/d口服,观察两组患者治疗前及治疗后4 w、12 w心绞痛发作的频率和发作的持续时间及不良反应.观察治疗前后血管内皮功能指数(RHI)变化,及心功能指标脑钠肽(BNP)和左室射血分数(LVEF)水平的变化.结果 治疗前后两组患者肝肾功能均无明显变化,治疗后两组患者心绞痛发作次数和持续时间均呈减少趋势,但观察组治疗4 w、12 w后心绞痛改善情况优于对照组(P＜0.05).综合治疗12 w后两组患者血浆BNP、LVEF、RHI指数均较治疗前好转(P＜0.05),并且观察组改善优于对照组,差异均有统计学意义(P＜0.05).结论 尼可地尔能够明显降低高龄冠脉多支病变患者的心绞痛发作,进一步改善血管内皮细胞功能,改善患者的心功能状态.%To observe the clinical efficacy of nicorandil in elderly patients with multi-vessel coronary artery lesions complicated by angina pectoris attack and cardiac insufficiency. Methods The elderly patients (n=131) with multi-vessel coronary artery lesions complicated by angina pectoris attack and cardiac insufficiency were chosen from Department of Geriatric Cardiovascular Medicine of the Seventh Medical Center of Chinese PLA General Hospital from Jan. 2016 to Jan. 2019, and divided randomly into control group (n=65) and observation group (n=66). The control group was given routine comprehensive therapies for angina pectoris and cardiac insufficiency, and observation group was additionally given nicorandil (5 mg, TID) orally. The frequency, duration and adverse reactions of angina pectoris attack were observed in 2 groups after treatment for 4 weeks and 12 weeks. The changes of reactive hyperemia index (RHI), brain natriuretic peptide (BNP) and left ventricular ejection fraction (LVEF) were observed before and after treatment. Results The liver and kidney functions had no significant changes before and after treatment. The times and duration of angina pectoris attack showed a descending trend, and the improvement of angina pectoris was better in observation group than that in control group after treatment for 4 weeks and 12 weeks (P<0.05). The indexes of BNP, LVEF and RHI were improved in 2 groups after treatment for 12 weeks (P<0.05), which was superior in observation group to that in control group (P<0.05). Conclusion Nicorandil can significantly relieve angina pectoris attack, and further improve vascular endothelial cell function and heart function in elderly patients with multi-vessel coronary artery lesions.

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