2022 年第 1 期 第 17 卷

尼可地尔联合单硝酸异山梨酯对冠状动脉慢性完全闭塞病变介入术后稳定型心绞痛的疗效

Effect of nicorandil combined with isosorbide mononitrate on stable angina pectoris in patients after chronic total occlusion intervention therapy

作者：张闽张东凤田晋帆南楠宋现涛

英文作者：Zhang Min Zhang Dongfeng Tian Jinfan Nan Nan Song Xiantao

单位：首都医科大学附属北京安贞医院心内科，北京100029

英文单位：Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：慢性完全闭塞病变；经皮冠状动脉介入；心绞痛；尼可地尔；单硝酸异山梨酯

英文关键词：Chronictotalocclusion;Percutaneouscoronaryintervention;Anginapectoris;Nicodil;Isosorbidemononitrate 

• 摘要：

• 目的  探讨尼可地尔联合单硝酸异山梨酯对冠状动脉慢性完全闭塞病变（CTO）介入术后稳定型心绞痛的疗效。方法 选取首都医科大学附属北京安贞医院2019年1月至2021年1月收治的冠状动脉CTO介入术后稳定型心绞痛患者100例，依据随机数字表法分为对照组和观察组，各50例。对照组在常规冠心病（冠状动脉粥样硬化性心脏病）二级预防药物治疗基础上联合单硝酸异山梨酯缓释片治疗，观察组在对照组治疗基础上联合尼可地尔片治疗。2组均持续治疗3个月。比较2组治疗前后心绞痛发作次数、单次心绞痛发作持续时间、6 min步行试验（6MWT）距离、生活质量、临床疗效和不良反应发生率。结果 治疗前2组心绞痛发作次数、心绞痛持续时间及6MWT比较差异均无统计学意义（均P＞0.05）；治疗后2组心绞痛发作次数均少于治疗前，持续时间均短于治疗前，6MWT均长于治疗前，且观察组改善程度均优于对照组［(3.6±1.3)次比（4.6±1.4）次、(2.6±0.8)min比（3.2±1.0）min、(520±178)m比（435±150）m］(均P<0.05）。治疗前2组心绞痛发作情况（AF）、心绞痛稳定状态（AS）、躯体活动受限程度（PL）、疾病认知程度、治疗满意程度（TS）评分比较差异均无统计学意义（均P＞0.05）；治疗后2组各项生活质量评分均高于治疗前，且观察组AF、AS、PL、TS评分均高于对照组(均P<0.05）。治疗3个月后，观察组总有效率高于对照组［92.0%（46/50）比76.0%（38/50）］（P=0.029），2组不良反应发生率比较差异无统计学意义（P=1.000）。结论  尼可地尔联合单硝酸异山梨酯能有效缓解冠状动脉CTO患者介入术后心绞痛发作情况、提高活动耐量、改善生活质量，且不良反应少。

• Objective   To investigate the effect of nicorandil combined with isosorbide mononitrate on stable angina pectoris after intervention therapy in chronic total occlusion (CTO). Methods  Total 100 patients with stable angina pectoris after coronary CTO intervention treated in Beijing Anzhen Hospital, Capital Medical University from January 2019 to January 2021 were enrolled. Patients were randomly divided into control group and observation group, with 50 cases in each group. The control group was treated with isosorbide mononitrate sustained-release tablets on the basis of routine secondary preventive drugs for coronary atherosclerotic heart disease, and the observation group was treated with nicorandil tablets on the basis of the control group. Both groups were treated for 3 months. The frequency of angina pectoris attack, duration of single angina pectoris attack, 6 min walk test (6MWT) distance, quality of life, clinical efficacy and incidence of adverse reactions were compared between the two groups before and after treatment. Results  There were no significant differences in the number of angina pectoris attack, duration of angina pectoris and 6MWT between the two groups before treatment (all P>0.05); after treatment, the number of angina pectoris attack in the two groups were less than that before treatment, the duration was shorter than that before treatment, 6MWT was longer than that before treatment, and those improvement degrees in the observation group were better than those in the control group ［(3.6±1.3)times vs (4.6±1.4)times, (2.6±0.8)min vs (3.2±1.0)min, (520±178)m vs (435±150)m］(all P<0.05). There were no significant differences in the scores of angina pectoris attack frequency (AF), stable state of angina pectoris (AS), physical activity limitation (PL), disease cognition and treatment satisfaction (TS) between the two groups before treatment (all P>0.05); after treatment, the scores of quality of life in the two groups were higher than those before treatment, and the scores of AF, AS, PL and TS in the observation group were higher than those in the control group (all P<0.05). After 3 months of treatment, the total effective rate in the observation group was higher than that in the control group ［92.0%(46/50) vs 76.0%(38/50)］（P=0.029). There was no significant difference in the incidence of adverse reactions between the two groups (P=1.000). Conclusion  Nicorandil combined with isosorbide mononitrate can effectively alleviate the attack of angina pectoris, improve activity tolerance and quality of life in patients with coronary CTO after intervention, and has few adverse reactions.