冠状动脉内注射山莨菪碱对急性心肌梗死介入治疗后缓再血流现象的作用

Effect of intracoronary administration of anisodamine on slow reflow phenomenon following primary percutaneous coronary intervention in patients with acute myocardial infarction

目的:评价冠状动脉内应用山莨菪碱对急性心肌梗死(AMI)经皮冠状动脉介入治疗(PCI,含经皮冠状动脉腔内成形术和支架置入术)后梗死相关动脉(IRA)缓再血流现象(slowreflowphenomenon,SRP)的疗效及其安全性。方法:121例AMI直接PCI后再通的IRA存在SRP患者21例,先以硝酸甘油200μg冠状动脉内注入(确认SRP)作为对照,10min后继以冠状动脉内注入山莨菪碱500μg(2min内),于给药后1、3、10min行冠状动脉造影(CAG)。应用Gibon的TIMI血流计帧法和QCA测量系统分别行硝酸甘油和山莨菪碱冠状动脉内给药后不同时间点IRA再通后血流速率帧数和管腔直径的定量分析比较。结果:①术后基础对照与硝酸甘油给药1、3、10min时CAG血流帧数比较无明显变化(P>0.05);山莨菪碱给药后1、3和10min时CAG血流帧数分别较给药前减少58.3%,56.2%和54.6%(均P<0.01),平均TIMI血流增加从(1.76±0.43)级到(2.71±0.46)级,P<0.05;②冠状动脉内给予山莨菪碱后3min时开通IRA中段管径亦较前略有增加[(3.2±0.4)mm∶(3.4±0.5)mm,P>0.05];③山莨菪碱冠状动脉内给药后10min内连续监测冠状动脉内压、外周血压、PR间期、QT间期和QRS时限各参数与给药前比较差异均无统计学意义(P>0.05)。心率较用药前增加了15～19次/min,但未引起严重的心动过速和心律失常。结论:冠状动脉内应用山莨菪碱500μg可改善AMI直接PCI后SRP,且安全易行,可作为治疗IRA开通后SRP的有效药物之一。

Objective： To assess the effect and safety of intracoronary adminstration of anisodamine on ＇slow reflow＇ phenomenon of infarct related artery（IRA） following primary percutaneous coronary intervention （PCI） in patients with acute myocardial infarction （AMI）. Method：Twenty one patients with AMI who had been success fully performed primary PCI were found ＇slow reflow＂ phenomenon. Nitroglycerin （200 μg） was injected. All da ta were analysized by Gibson＇s TIMI frame count method and quantitative computer angiography（QCA）system. Result：①No significant change was found at 1, 3, and 10 min after intracornary administration of nitroglycerin （ P 〉0. 05）;TIMI frames count was decreased by 58.30%,56.2% ,and 54.6% at 1,3, and 10 min, respectively, and average coronary blood flow of TIMI grade was improved from （1.76±0.43）to （2.71±0.46） （ P 〈0.05） af ter intraeoronary administration of anisodamine. ②The diameter of middle segment of reopened coronary artery was increased from （3.2±0.4） mm to （3.4±0.5） mm at 3rd rain after intracoronary administration of anisodamine （ P 〉0. 05）. ③During and after intracoronary administration of anisodamine, blood pressure, PR interval,QT interval, and QRS duration were not found any significant changes（ P 〉0.05）. The heart rate inceased significantly but no tachycardia and other malignant arrythmia happened. Conclusion：Intracoronary administration of anisodamine 500μg （2 min） proved to be safe and easy clinically attenuate ＇slow reflow＇ phenomenon following primary PCI in patients with AMI, and might be one of first choices in medical therapy for ＂slow reflow＇ phenomenon.