Abstract:

Objective　To investigate the efficacy of nicorandil combined with amiodarone in the treatment of coronary heart disease with angina pectoris. Methods　The clinical data of 120 patients with coronary heart disease and angina pectoris admitted to the First People's Hospital of Nanyang City from April 2022 to April 2024 were collected for a retrospective study. They were divided into a reference group (61 cases) and a study group (59 cases) according to different treatment plans. In the reference group, there were 33 males and 28 females, aged (56.02±7.52) years, the course of disease was (3.25±0.63) years, and the grading of cardiac function was as follows: 16 cases of grade I, 35 cases of grade II, and 10 cases of grade III. In the study group, there were 35 males and 24 females, aged (57.96±7.46) years, the course of disease was (3.50±0.82) years, and the grading of cardiac function was as follows: 15 cases of grade I, 33 cases of grade II, and 11 cases of grade III. The reference group was treated with oral nicorandil tablets, 5 mg/time, 3 times/day. The study group was given amiodarone injection intravenously on the basis of the reference group, and 150 mg of amiodarone injection was dissolved in 20 ml of normal saline, amiodarone injection was injected slowly for 20 min, then at the rate of 1 mg/min for 6 h, and then gradually reduced to 0.5 mg/min, with the total amount within 24 h less than 2 000 mg; after the heart rate recovered, amiodarone tablets were taken orally, 0.2 g/time, twice a day. Both groups were treated for 4 weeks. The clinical symptoms, cardiac function indicators, and serum levels of relevant cytokines [hypersensitive C-reactive protein (hs-CRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2)] before and after treatment and the total incidence of adverse reactions were compared between the two groups. χ² test and t test were used for statistical analysis. Results　After treatment, the frequency of angina pectoris in the study group was less than that in the reference group, and the duration of angina pectoris attacks was shorter [(1.02±0.28) times/week vs. (2.37±0.61) times/week, (2.77±0.92) min/time vs. (4.01±0.85) min/time]; the left ventricular end-systolic diameter was smaller than that in the reference group, and the left ventricular ejection fraction was higher than that in the reference group [(32.88±3.41) mm vs. (39.73±3.27) mm, (50.25±3.04)% vs. (48.12±3.15)%]; the levels of hs-CRP and Lp-PLA2 were lower than those in the reference group [(5.32±1.14) mg/L vs. (10.75±1.03) mg/L, (20.76±3.96) µg/L vs. (35.24±4.35) µg/L], with statistically significant differences (t=-15.664, -7.662, -11.225, 3.769, -27.349, and -19.079, all P<0.001). The total incidence of adverse reactions in the study group was slightly higher than that in the reference group [8.20% (5/61) vs. 5.08% (3/59)], but the difference was not statistically significant (χ²=0.467, P=0.494). Conclusion　Nicorandil combined with amiodarone can effectively alleviate the clinical symptoms, inhibit the inflammatory reactions, maintain the plaque stability, improve the cardiac function, and has high safety in patients with coronary heart disease and angina pectoris.

Key words:

Coronary heart disease, Angina pectoris, Amiodarone, Nicorandil, Curative effect

摘要：

目的　探讨尼可地尔联合胺碘酮治疗冠心病心绞痛患者的效果。方法　收集2022年4月至2024年4月南阳市第一人民医院收治的120例冠心病心绞痛患者临床资料进行回顾性研究，按治疗方案不同分为参照组、研究组。参照组61例中男33例、女28例，年龄（56.02±7.52）岁，病程（3.25±0.63）年，心功能分级：Ⅰ级16例、Ⅱ级35例、Ⅲ级10例。研究组59例中男35例、女24例，年龄（57.96±7.46）岁，病程（3.50±0.82）年，心功能分级：Ⅰ级15例、Ⅱ级33例、Ⅲ级11例。两组均予常规基础治疗（口服阿司匹林、美托洛尔片、阿托伐他汀钙片）。参照组联合尼可地尔片治疗，口服，5 mg/次，3次/d。研究组在参照组基础上联合胺碘酮治疗，150 mg胺碘酮注射液加入20 ml 5%葡萄糖注射液中充分溶解，静脉注射，在20 min内完成；再以1 mg/min速率采用微量注射泵持续泵入，6 h后逐渐减量至0.5 mg/min，24 h内总量≤2 000 mg。待心率恢复正常后，改为口服胺碘酮片，0.2 g/次，2次/d。两组均持续治疗4周。比较两组治疗前后临床症状、心功能指标、血清相关细胞因子［超敏C反应蛋白（hs-CRP）、脂蛋白相关磷脂酶A2（Lp-PLA2）］及不良反应总发生率。采用χ²检验、t检验进行统计分析。结果　治疗后，研究组心绞痛症状发作次数少于参照组、发作持续时间短于参照组［（1.02±0.28）次/周比（2.37±0.61）次/周、（2.77±0.92）min/次比（4.01±0.85）min/次］；左心室收缩末期内径小于参照组、左心室射血分数高于参照组［（32.88±3.41）mm比（39.73±3.27）mm、（50.25±3.04）%比（48.12±3.15）%］；hs-CRP、Lp-PLA2水平均低于参照组［（5.32±1.14）mg/L比（10.75±1.03）mg/L、（20.76±3.96）µg/L比（35.24±4.35）µg/L］，差异均有统计学意义（t=-15.664、-7.662、-11.225、3.769、-27.349、-19.079，均P<0.001）。研究组不良反应总发生率略高于参照组［8.20%（5/61）比5.08%（3/59）］，但差异无统计学意义（χ²=0.467，P=0.494）。结论　尼可地尔联合胺碘酮治疗冠心病心绞痛患者，可有效缓解其临床症状，抑制炎症反应，维持斑块稳定，改善心功能，且安全性较高。

关键词:

冠心病, 心绞痛, 胺碘酮, 尼可地尔, 疗效