尼可地尔在非体外循环下冠状动脉旁路移植术中对前降支血流灌注的影响
The Effect of Nicorandil on Blood Flow Perfusion in the Left Anterior Descending Artery during Off-Pump Coronary Artery Bypass Grafting
DOI: 10.12677/acm.2025.1551507, PDF,   
作者: 蒋玉洁：青岛大学医学院，山东 青岛；杨苏民*：青岛大学附属医院心血管外科，山东 青岛
关键词: 移植物血流；尼可地尔；左乳内动脉；冠心病；Graft Blood Flow； Nicorandil； Left Internal Mammary Artery； Coronary Heart Disease
摘要: 目的：本研究旨在探讨尼可地尔输注对于接受非体外循环冠状动脉旁路移植术的患者，其动脉移植物血流的影响。方法：总共100名符合条件的患者，共有100个动脉移植物，接受了单独的冠状动脉旁路移植手术，并以1:1的比例随机分配到尼可地尔组或对照组。两组均使用标准的抗心绞痛治疗，进行左乳内动脉(LIMA)与病变的前降支(LAD)缝合操作，尼可地尔组(n = 50)的患者在完成LIMA-LAD操作后接受尼可地尔输注，而对照组(n = 50)的患者则在LIMA-LAD操作后接受生理盐水输注。所有移植物均通过流量仪进行术中血流测量。主要比较了使用尼可地尔或盐水前后左内乳动脉血流变化。结果：在使用尼可地尔和生理盐水干预前，尼可地尔组与对照组的LIMA-LAD移植物流量无统计学意义的差异(P > 0.05)。然而，在使用尼可地尔和生理盐水干预后，复测两组的LIMA-LAD移植物流量有显著差异(P < 0.05)，尼可地尔组的动脉桥流量高于对照组。在尼可地尔组，使用尼可地尔后复测的LIMA-LAD移植物流量大于使用尼可地尔前的流量，差异有统计学意义(P < 0.05)。相反，在对照组，使用生理盐水后复测的LIMA-LAD移植物流量小于使用生理盐水前的流量(P < 0.05)。结论：尼可地尔对冠状动脉旁路移植术中前降支的心肌血流灌注有显著影响。
Abstract: Objective: This study aimed to investigate the effect of nicorandil infusion on arterial graft blood flow in patients undergoing off-pump coronary artery bypass grafting (OPCAB). Methods: A total of 100 eligible patients with 100 arterial grafts undergoing isolated coronary artery bypass surgery were randomly assigned in a 1:1 ratio to either the nicorandil group or the control group. Both groups received standard anti-anginal therapy and underwent left internal mammary artery (LIMA)-to-left anterior descending artery (LAD) anastomosis. Patients in the nicorandil group (n = 50) received nicorandil infusion after completing the LIMA-LAD anastomosis, while the control group (n = 50) received normal saline infusion post-anastomosis. Intraoperative graft blood flow was measured using a flowmeter. The study primarily compared the changes in blood flow of the left internal mammary artery before and after the administration of nicorandil or saline. Results: Baseline LIMA-LAD graft flow showed no statistically significant difference between the nicorandil and control groups before intervention (P > 0.05). However, after intervention, significant differences were observed in post-intervention LIMA-LAD graft flow between the two groups (P < 0.05), with higher arterial graft flow in the nicorandil group. In the nicorandil group, post-intervention graft flow was significantly increased compared to pre-intervention flow (P < 0.05). Conversely, in the control group, post-intervention graft flow decreased compared to pre-intervention flow (P < 0.05). Conclusion: Nicorandil significantly enhances myocardial blood perfusion in the LAD territory during coronary artery bypass grafting.
文章引用：蒋玉洁, 杨苏民. 尼可地尔在非体外循环下冠状动脉旁路移植术中对前降支血流灌注的影响[J]. 临床医学进展, 2025, 15(5): 1396-1406. https://doi.org/10.12677/acm.2025.1551507

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