弹丸注射不同剂量三磷酸腺苷的冠状动脉血流储备分数比较

The application of different doses of intracoronary injection of ATP for estimating fractional flow reserve in coronary artery disease

目的测定冠状动脉血流储备分数(FFR),探讨冠状动脉内注射三磷酸腺苷(ATP)的最佳剂量。方法选取冠心病患者50例,52处临界病变(狭窄程度为40%~70%)为研究对象进行FFR测量。将不同剂量的ATP[60μg(IC1)、100μg(IC2)、150μg(IC3)、200μg(IC4)、250μg(IC5)]以弹丸注射至靶血管,然后肘静脉以140μg·kg-1·min-1速度泵入ATP(IV组),分别测定并记录FFR值、心率、血压、不良反应等情况。结果随着冠脉内弹丸注射剂量的增加,FFR值逐渐减小,但IC4组与IC5组的FFR值差异无统计学意义。IC1组FFR值明显大于IV组的FFR值[差值为(0.021±0.012)分,P<0.05];IC4、IC5组的FFR值明显小于IV组[差值分别为(-0.030±0.015)分,P<0.05及(-0.031±0.017)分,P=0.001]。各组间血压、心率差异无统计学意义。13例患者出现ATP相关不良反应。结论在安全性相同前提下,相比于静脉泵入ATP,冠脉内弹丸注射ATP的剂量为200μg时诱发最大充血状态效果更佳。

Objective To explore the optimal dose of intracoronary adenosine triphosphate （ATP） on fractional flow reserve （FFR） measurement. Methods FFR was assessed in 50 patients with 52 intermediate lesions. Different dose of intracoronary ATP[60 μg（IC1）,100 μg（IC2） ,150 μg（IC3） ,200μg（ICA）,240 μg（ICS） as boli] were randomly ad- ministered. Then a intravenous infusion of 140 μg·kg^-1·min^-1 was administered. FFR values, heart rate, blood pressure, systemic effects and so on were recorded. Results The FFR value decreased with the increasing intracoronary ATP injection rates ,no further decrease was observed after IC4, IC1 （0.021 ± 0.012 ,P 〈 0.05 ） was associated with a greater FFR compared to the Ⅳ. ICA and IC5 were associated with a smaller FFR compared to the IV （ -0.030 ±0. 015 ,P 〈0.05 and -0.031 ±0.017,P =0. 001 ）. There was no significant difference in blood pressure and heart rate between the groups. A total of 13 patients （40.6%） reported at least one side effects. Conclusion A dose of 200 μg of intracoronary ATP is superior to intravenous in achieving maximum hyperemia with a good safety.