地尔硫?联合肾上腺素对急性ST段抬高型心肌梗死患者冠脉介入无复流的影响

The effect of intravascular diltiazem and adrenalin injection in occlusion site of coronary artery on no-reflow in patients with acute ST segment elevation myocardial infarction

目的:观察冠状动脉(冠脉)闭塞段近端注射地尔硫?及肾上腺素对急性ST段抬高型心肌梗死(STEMI)患者经皮冠脉介入治疗(PCI)中无复流的影响。方法:82例诊断为STEMI行急诊PCI患者,随机分为地尔硫组与地尔硫?+肾上腺素组,每组41例。两组患者均术中行血栓抽吸,于冠脉支架植入前后冠脉内注射地尔硫?或地尔硫?联合肾上腺素,观察冠脉血流(TIMI)及心肌灌注(TMPG)情况,检测患者PCI术前、术后、术后12h、术后24h静脉血中内皮素-1(ET-1)、血小板内皮细胞黏附分子(PECAM-1)及内源性一氧化氮(NO)水平,1~2周后记录患者左室射血分数(LVEF)、左室舒张末期内径(LVEED)、氨基末端B型脑钠肽前体(NTproBNP)水平。结果:支架植入前(初次)与支架植入后(末次)造影结果提示,地尔硫?+肾上腺素组达到TIMI 3级血流和TMPG 3级比例显著高于地尔硫组(均P<0.05);地尔硫?+肾上腺素组患者术后ET、PECAM-1及内源性NO水平较地尔硫组明显改善(均P<0.05),且发生低血压的患者少于地尔硫组(P<0.05)。结论:地尔硫联合肾上腺素可改善冠脉血运及内皮功能,有效减少冠脉无复流及术中低血压发生,从而改善患者预后。

Objective：To observe the effect of diltiazem hydrochloride and adrenaline on re-flow in patients with acute ST-segment elevation myocardial infarction（STEMI）during percutaneous coronary intervention（PCI）.Method：Eighty-two patients with STEMI were randomly divided into diltiazem group and diltiazem＋adrenalin group（n=41,respectively）.The patients in both groups were treated with thrombolysis before operation.The TIMI and TMPG were measured after injection with diltiazem and diltiazem ＋ adrenalin before and after coronary stent implantation,respectively.And level of ET-1,PECAM-1 and endogenous NO were measured before and after PCI.LVEF,LVEED and NT-proBNP were recorded 1-2 weeks later.Result：The ratio of coronary blood flow in TIMI grade 3 and MPG grade 3 in diltiazem ＋adrenalin group was significantly higher than that in diltiazem group before and after the stent implantation（both P0.05）.The levels of ET,PECAM-1 and endogenous NO in diltiazem＋adrenalin group were significantly higher than those in diltiazem group（all P0.05）.The incidence of hypotension in diltiazem ＋adrenalin group was significant lower than that in diltiazem group.Conclusion：Intravascular diltiazem and adrenalin injection improve coronary blood supply and endothelial function,it was more effective than diltiazem in prevention of coronary no-reflow and hypotension in PCI,and improve the prognosis.