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【目的】冠動脈ステント留置後の血液凝周線溶能と血小板機能に及ぼすisosorbidedinitrateとnicorandil併用療法の効果を検討した.【方法】対象は冠動脈ステント留置患者21名.ステント留置後isosorbide dinitrate(I)を0.025mg/kg/hr単独静注した11名(C群)とI 0.025mg/kg/hr+nicorandil 6mg/hr併用静注した10名(N群)に分けた.ステント後と翌朝にfibrinopeptideA(F),tPA-PAI 1 complex(T),serotonin(S)を測定した.【結果】(1)両群ともステント留置翌朝にFは有意の上昇を認めた.TはN群で有意に上昇,C群では上昇傾向を認めた.(2) SはN群の10例中9例に低下(3.31±4.48→1.41±2.23ng/ml:p<0.05)したが,C群では不変であった.【総括】両群ともステント後の血液凝固能の抑制効果は不十分であったが,急性期血小板活性化に関しては併用群に抑制効果を認めた.nicorandil併用療法は冠動脈ステント後急性期血栓性合併症を予防する可能性が示唆された.
To evaluate the effects of combined therapy using isosorbide dinitrate (ISDN) and nicorandil both on the coagulation system and on platelet activity after coronary stenting. Fibrinopeptide A, tPA-PAI 1 complex and serotonin from 21 patients were estimated after coronary stenting and on the next morning. After successful placement of coronary stents, 11 patients were randomly assigned to receive intravenous ISDN (group C) and 10 were assigned to receive combined therapy with ISDN and nicorandil (group N). The plasma level of fibrinopeptide A had increased significantly by the next morning in both groups (group C ; 1.72±0.93 to 4.42±4.30 ng/ml, p <(1.05, group N ; 1.13±0.42 to 3.57±2.64, p <0.02). The tPA-PAI I complex had increased significantly in group N ( 16.7±8.2 to36.9±26.7ng/ml, p<0.05), and in group C (18.8±9.3 to 23.9 ± 14.7, p =0.11) . Serotonin had decreased significantly in group N (3.31 ± 4.48 to 1.41±2.23 ng/ ml, p<0.05), while there was no significant change in group C (2.17 ± 2.87 to 1.69 ± 1.79 ng/ml) . Conclusion : This study demonstrates that the administration of both ISDN and nicorandil decreased plasma level of serotonin after coronary stenting. This suggests the suppression of platelet activity. Combined therapy with ISDN and nicorandil may reduce the risk of coronary thrombus formation after stenting.
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