摘要
硝普钠(NTP)被用于治疗冠状动脉介入治疗后的冠状动脉慢血流(SCF)。在以往报道中剂量、给药途径以及给药时间差异较大,妨碍了对其效果的客观评价。本文报道了在成功置入支架后SCF的发生率,以及予标准NTP方案治疗后的变化。2005年1月至10月间成功置入支架的2212例连续患者中有21例出现SCF,对这21例患者选择性冠状动脉内给予递增剂量NTP(首剂80μg,随后以40μg递增)并进行评估。SCF仅见于急性心肌梗死(AMI;11.5%,105例中的12例)或大隐静脉桥血管(SVG)狭窄(8.2%,109例中出现9例)的患者中。
Nitroprusside(NTP) is used for the treatment of slow coronary flow(SCF) after coronary interventions. The wide variation in dosage, route, and timing of its administration in the reported studies prevents an objective assessment of its efficacy. We report the incidence and response to a standardized NTP protocol of SCF after successful stent implantation. Selective intracoronary administration of incremental doses(initial bolus of 80 μ g incremented by 40 μ g) of NPT was assessed in 21 patients who developed SCF in a series of 2,212 consecutive patients who underwent successful stent placement from January to October 2005. SCF was observed only in patients treated for acute myocardial infarction(AMI; 11.5% , 12 of 105) or saphenous vein graft(SVG) stenosis(8.2% , 9 of 109). An intracoronary bolus of nitroglycerin did not restore normal Thrombolysis In Myocardial Infarction(TIMI) flow in any patient. The first 80-μ g dose of NTP restored normal TIMI flow in 58% of patients(7 of 12) with AMI and in 44% of patients(4 of 9)with SVG stenosis. The maximal dose(120/160 μ g) restored normal TIMI flow in all remaining patients with AMI but in only 1 additional patient with SVG stenosis. At the end of the procedure, the percent decrease in corrected TIMI frame count was significantly larger in patients with AMI(- 44± 10% ) than in those with SVG stenosis(- 24± 16% , p=0.02). In a large consecutive series of successful stent procedures, SCF was found only in patients with ST-elevation AMI(11.5% ) or with a stenosed SVG(8.2% ). In conclusion, the standardized protocol of intracoronary NTP administration succeeded in normalizing SCF in all patients with AMI but in only 5 of 9 patients with SVG stenosis. This latter subgroup requires other therapeutic strategies.
