冠脉内注射山莨菪碱及腺苷对急性心肌梗死患者介入治疗后缓再流现象的影响

lntracoronary Administration of Combined Anisodamine with Adenosine Improves Slow Reflow Phenomenon After Pri- mary Percutaneous Coronarv Intervention in Patients with Acute Mvocardial Infarction

背景急性心肌梗死(AMI)经皮冠状动脉介入治疗(PCI)后约10%～30%的患者存在缓再流现象(SRP),致使患者不能实现心肌组织水平的有效再灌注,探讨 PCI 后 SRP 防治方法成为冠状动脉介入治疗领域的一个研究热点。目的探讨冠状动脉内注射山莨菪碱及联合腺苷对 AMI 患者 PCI 后梗死相关动脉(IRA)SRP 的影响。方法 51例 AMI 直接 PCI 后存在 SRP 者,先以硝酸甘油200μg冠状动脉内注入确认 SRP,再随机分为两组:A 组(26例)冠状动脉内注入山莨菪碱500μg,B 组(25例)注入山莨菪碱500μg+腺苷3 mg,两组于给药后1、3、10 min 行冠状动脉造影(CAG)。应用 TIMI 血流计帧法和冠状动脉造影计算机测量系统行给药后不同时间点IRA 再通后血流速率帧数定量分析比较,并观察用药前后的心率和血压变化。结果术后基础对照与硝酸甘油给药1、3、10 min 时 CAG 血流帧数比较差异无统计学意义(P>0.05)。A 组给药后1、3和10 min 时 CAG 血流帧数分别较给药前减少56.6%,54.4%和52.8%(P 均<0.01),平均 TIMI 血流从(1.75±0.46)级增加到(2.73±0.44)级(P<0.05);B 组较给药前减少59.5%,58.6%和55.8%(P 均<0.01),平均 TIMI 血流从(1.72±0.52)级增加到(2.82±0.36)级(P<0.05),组间差别显著。两组在给药后10 min 内连续监测冠状动脉内压、外周血压与给药前比较差异无统计学意义(P>0.05)。A 组心率较用药前增加了15～19次/min,B 组心率未见增加,两组均未发现严重不良反应。结论冠状动脉内注射山莨菪碱联合腺苷可改善 AMI 直接 PCI 后 SRP,对血压和心率无影响。

Background The slow reflow phenomenon（SRP） occurred in 10 %-30 % patients with acute myocardial infarction （AMI） after percutaneous coronary intervention（PCI） indicating no enough perfusion was restored. Prevention and treatment SRP will improve the mortality and morbility after AMI. Objective To study the effect of intracoronary administration in infarct related artery（IRA） by combined anisodamine and adenosine on SRP after primary PCI in patients with AMI. Methods Fifty-one patients were received intracoronary injection of anisodamine （500 μg anisodamine, n= 26, group A） or anisodamine plus adenosine （500 μg anisodamine＋adenosine 3 mg, n = 25, group B） after 10 minutes after nitroglycerin （200μg）. TIMI frame count was counted at 1, 3, and 10 min as index of speed and extant of repenfusion. Results No significant change of frame numbers in TIMI was found at 1, 3 and 10 min after intracoronary administration of nitroglycerin （P〉0.05）. However, TIMI frames count was decreased by 56.6%, 54.4%, and 52.8% at 1 min, 3 min and 10 min, respectively, with average TIMI grade improved from （1.75±0. 46） to （2.73±0. 44） （P±0.05） after anisodamine. Combined treatment significantly decreased TIMI frames count by 59.5%, 58. 6%, and 55.8% and increased average coronary blood flow of TIMI grade from （1.72 ± 0.52） to （2.82 ± 0. 36） （P±0.05） with no changes in blood pressure（P〉0.05）. The heart rate was increased significantly in goup A but not in group B. Conclusion Intracoronary administration of combined anisodamine with adenosine is safe and effective to prevent SRP after primary PCI in patients with AMI.