小剂量阿托品对急性右冠状动脉梗塞介入治疗术中再灌注心律失常的影响

The effect of atropine on the reperfusion arrhythmias during percutaneous coronary intervention with acute right coronary infarction

目的观察小剂量阿托品对急性右冠状动脉梗塞急诊冠状动脉(简称冠脉)介入治疗术中再灌注心律失常的影响。方法 128例冠脉造影显示急性右冠脉闭塞致心肌梗死(简称心梗)患者,分为阿托品组(66例)和对照组(62例),阿托品组冠脉开通前给予小剂量阿托品0.5 mg静脉注射,对照组不给予阿托品干预,观察两组再灌注心律失常发生情况。结果阿托品组发生再灌注心律失常27例,其中快速心律失常16例,缓慢心律失常11例,术后低血压13例,对照组发生再灌注心律失常47例,其中快速心律失常15例,缓慢心律失常32例,术后低血压24例,两组缓慢性心律失常和低血压发生率有显著差异(P<0.05),而两组快速心律失常发生率无统计学差异。结论对急性右冠脉心梗患者,急诊开通冠脉前,给予小剂量阿托品可以减少再灌注引起的缓慢性心律失常及低血压的发生率。

Objective To evaluate the effect of atropine on the reperfusion arrhythmias （RA） during percutaneous coronary intervention （PC/） with acute right coronary infarction. Methods One hundred and twenty-eight patients with right coronary artery infarction treated by PCI within 12 hours were divided into the atropine treatment group and the control group. In the atropine treatment group ,66 cases were intravenously injected atropine 0.5 mg before opening the coronary artery,and in the control group 62 cases were not giren atropine. And a comparison was made on the incidences, frequency and the type of arrhythmia after PCI between the two groups. Results RA occurred in 27 cases in the atropine treatment group, 16 cases were taehyarrhythmias, including premature ventricular beats （PVB） in 9 cases, ventrieular taehycardia （VT） in 5 cases, ventricular fibrillation（VF） in 2 cases; 11 cases were bradyarrhythmias, including sinus bradycardia in 4 eases, sinus arrest in 2 cases, atrioventrieular conduction block（AVB） in 5 cases. RA occurred in 47 cases in the control group, 15 cases were taehyarrhythmias, including PVB in 8 cases, VT in 4 cases, VF in 3 cases; 32 cases were brady-arrhythmias, including sinus bradycardia in 18 cases ,sinus arrest in 6 cases, AVB in 8 cases. 13 patients oecured postop-erative hopertension after PCI in atropine treatment group,but 24 patients occured postoperative hopertension in the control group. The incidence of bradyarrhythmias and hopertension after PCI were significant higher in the control group than those in atropine treatment group （ P 〈 0. 05 ）, but the incidence of tachyarrhythmias was not significant difference between two groups（ P 〉 0. 05 ）. Conclusion Giving small doses of atropine before coronary opening can reduce reperfusion-induced arrhythmias and incidence of hypotension in acute right coronary infareition patients.