肾上腺素与维拉帕米冠脉注射对心肌梗死PCI术中慢血流影响的对比

Comparison of the effects of epinephrine and Vera Pammy coronary injection on the slow flow during myocardial infarction PCI

目的 探究心肌梗死经皮冠状动脉介入治疗（PCI）术中出现慢血流患者冠脉内注射肾上腺素与维拉帕米的疗效.方法 选取2013年1月-2016年10月于上海市嘉定区中医医院接受急性心肌梗死PCI治疗的术中出现慢血流患者68例,按照随随机数表法分为肾上腺素组37例和维拉帕米组31例.2组患者在手术前均进行常规用药,肾上腺素组向冠状动脉内注射50μg肾上腺素,维拉帕米组注射200μg维拉帕米.观察2组患者冠脉造影情况、血流动力学情况以及生物化学等检测指标比较情况.结果 肾上腺素组初次用药后的TIMI血流分级3级比率为81.80%,明显高于维拉帕米组的64.52%（P〈0.05）.而三次用药后的TIMI血流分级3级比率、初次用药后的CTFC值、三次用药后的CTFC值相似,差异无统计学无意义.肾上腺素组的血压值为（82.67±10.87）mmHg,明显高于维拉帕米组的（70.46±9.54）mmHg（P〈0.05）.2组患者NT-proBNP、cTnT、LVEF值相似,差异无统计学意义.肾上腺素组的hs-CRP为（7.68±0.76）mg/L,明显低于维拉帕米组的（9.25±1.05）mg/L（P〈0.05）.结论 急性心肌梗死经皮冠状动脉介入治疗术中出现慢血流患者冠脉内注射肾上腺素与维拉帕米的疗效有所不同,使用肾上腺素能够显著提高血压,并且初次用药的效果更好.

Objective To explore the effect of intracoronary injection of epinephrine and Vera Pammy in patients with myocardial infarction with slow blood flowduring percutaneous coronary intervention （PCI）.MethodsFrom January 2013 to October 2016, 68 patients with acute myocardial infarction with solw blood flow in Shanghai Jiading Hospital of Traditional Chinese Medicine during PCI were randomly divided into the epinephrine group（37 cases） and the verapamil group（31 cases）.The two groups were treated with conventional drugs before surgery.The epinephrine group were injected into the coronary artery of 50 micrograms of epinephrine, the Vera Pammy group were injected into 200 micrograms of Vera Pammy.The coronary angiography, blood flow dynamics, as well as biochemical indexes in the two groups were observed.ResultsAfter the initial medicine, the ratio of TIMI flow grade 3 in the epinephrine group 81.80% was significantly higher than that in the Vera Pammy group 64.52%（P〈0.05）.The ratio of TIMI flow grade 3 after three times treatment, CTFC value after initial and 3 times treatment between the two groups have no significance.The blood pressure in the epinephrine group was （82.67±10.87） mmHg, which was significantly higher than that in the Vera Pammy group （70.46±9.54） mmHg（P〈0.05）.NT-proBNP, cTnT, LVEF in the two groups have no significance.hs-CRP in the epinephrine group was （7.68± 0.76） mg/L, which was significantly lower than that in the Vera Pammy group （9.25±1.05） mg/L.ConclusionThe effect is different which epinephrine and Vera Pammy were used in the patients with myocardial infarction with slow blood flowduring percutaneous coronary intervention.The use of epinephrine can significantly increase blood pressure, and the effect of initial medication is better.