冠状动脉内应用硝酸甘油和维拉帕米治疗冠状动脉血流缓慢现象的效果

Effects of intracoronary administration of nitroglycerin and verapamil for treatment of coronary slow flow phenomenon

目的研究硝酸甘油和维拉帕米对冠状动脉（冠脉）血流缓慢现象的治疗效果。方法入选64例因胸痛行冠脉造影证实心外膜主要冠脉血管无狭窄病变但血流缓慢的患者，根据治疗用药分为硝酸甘油组（35例）和维拉帕米组（29例）；选取年龄、性别、心血管危险因素等匹配而冠脉血流正常的29例患者为对照组。冠脉血流缓慢定义为造影剂在3个心动周期内不能到达血管末端。硝酸甘油组患者于造影后经造影管冠脉内注入硝酸甘油100～400μg后重复造影至血流明显改善；维拉帕米组则注入维拉帕米100—400峭至血流明显改善。以TIMI帧计数（TFC）法定量评价冠脉血流，比较冠脉血流缓慢患者使用硝酸甘油、维拉帕米前后的TFC值和血流正常者的TFC值，以及两组冠脉血流缓慢患者分别使用硝酸甘油和维拉帕米后的TFC变化值。结果存在血流缓慢的前降支、回旋支、右冠脉的基础TFC值在维拉帕米组分别为78．3±19．4、57．2±14．6、56．9±12．5，硝酸甘油组分别为70．8±21．7、55．3±12．5、51．1±15．4，对照组三支血管的TFC值分别为29．2±4．4、23．1±3．5、19．7±1．8。维拉帕米组治疗后TFC值分别下降至37．7±9．3、31．5±11．3、24．6±4．4（与基础状态比较，均P〈0．01），硝酸甘油组治疗后TFC值分别下降至42．3±8．9、36．7±6．8、30．3±5．9（与基础状态比较，均P〈0．01）；但均高于正常对照组（均P〈0．05）。而维拉帕米组用药前后的TFC变化值大于硝酸甘油组（均P〈0．05）。结论冠脉血流缓慢患者冠脉内注射维拉帕米的即刻治疗效果优于硝酸甘油，但两组患者冠脉血流仍未恢复到正常水平。

Objective To assess the efficacy of intracoronary nitroglycerin and verapamil for patients with the coronary slow flow phenomenon （CSFP）. Methods Sixty-four patients with CSFP without stenotic lesions during diagnostic coronary angiography were enrolled and divided into the nitroglycerin group （ n = 35 ） and verapamil group （ n = 29 ）, 29 patients with normal coronary flow served as normal control. CSFP was defined when 4 or more heart beats were needed for contrast media to opacify the distal vasculature. Intracoronary injection of 100-400μg nitroglycerin or verapamil through the diagnostic catheter was applied to patients with CSFP to improve coronary flow. The coronary blood flow was evaluated by thrombolysis in myocardial infarction （TIMI） frame count （TFC） method. Results Clinical characteristics were similar among the three groups. The basic TFCs of left anterior descending artery （ LAD）, left circumflex artery （LCX） and right coronary artery （RCA） were 78.3 ± 19.4, 57. 2 ± 14. 6, 56. 9 ± 12. 5 in the verapamil group, and were 70. 8 ± 21.7, 55.3 ±12. 5, 51.1 ± 15.4 in the nitroglycerin group, respectively, which were significantly higher than those in the normal controls （LAD 29. 2 ± 4. 4, LCX 23. 1 ± 3. 5 and RCA 19. 7 ± 1.8, respectively）. After the administration of drugs, the TFCs of LAD, LGX and RCA were 42. 3 ±8.9, 36.7 ±6. 8, 30. 3 ±5. 9 respectively （all P 〈0. 01 vs. baseline） in the nitroglycerin group and 37. 7 ±9. 3, 31.5 ± 11.3, 24. 6 ±4.4 respectively （all P 〈0. 01 vs. baseline） in the verapamil group. The TFCs after drug administration in both therapy groups were significantly higher than that in normal controls （ all P 〈 0. 05 ）. The TFCs decrease in the verapamil group were more significant than that in the nitroglycerin group （ all P 〈 0. 05 ）. Conclusion Intracoronary administration of verapamil could result in more coronary flow improvement in patients with CSFP than nitroglycerin, although the post therapy coronary flow was still slower than normal.