腺苷对NSTEMI无复流现象的预防

Preventive Effect of Adenosine for No-reflow Phenomenon in Patients with Acute Non-ST-segment Elevation Myocardial Infarction

目的研究在球囊扩张和支架释放前通过指引导管向梗死相关的冠状动脉内预防性注射腺苷对于急性非ST段抬高心肌梗死(NSTEMI)患者行直接经皮冠状动脉介入治疗(PPCI)时无复流现象(NRP)的防治效果。方法采用前瞻随机对照设计,选择2020年1月至2022年6月在昆明市延安医院心内科行PPCI的NSTEMI患者196例,采用随机数字表法分为预防性腺苷给药组(在第1次球囊预扩张后和后续每次球囊预扩张和每次支架置入前经指引导管冠状动脉内注射腺苷)和补救性腺苷给药组(发生NRP后再经指引导管冠状动脉内注射腺苷)。PPCI结束时观察梗死相关血管的心肌梗死溶栓试验(TIMI)血流分级、心肌TIMI灌注分级(TMPG)、心肌染色分级(MBG)及NRP的发生率。结果支架置入完成后,预防性给药组的梗死相关血管血流TIMI、TMPG和MBG分级均达到3级的患者比例为89.6%,补救性给药组的比例为73.4%,差异有统计学意义(P<0.05);冠状动脉罪犯血管NRP的发生率,预防性给药组为8.2%,补救性给药组为23.6%,差异有统计学意义(P<0.05);所有发生NRP的患者,经指引导管冠状动脉内注射腺苷后,均恢复TIMI、TMPG、MBG分级3级。结论对于适宜的NSTEMI患者行PPCI时,在第1次球囊预扩张后和后续每次球囊预扩张和每次支架置入前经指引导管冠状动脉内预防性注射腺苷能够明显降低NRP的发生率。

Objective To study the effect of intracoronary injection of adenosine for the prevention of noreflow phenomenon(NRP)before balloon dilation and stent placement during primary percutaneous coronary intervention(PPCI)in patients with acute non-ST-segment elevation myocardial infarction(NSTEMI).Methods A prospective randomized controlled design was used to select 196 NSTEMI patients who received PPCI in the Department of Cardiology,Yan’an Hospital,from January 2020 to June 2022.Randomized number table method was used to divide the patients into two groups,with 98 patients in each group.Patients in one group were treated with intracoronary injection of 100μg adenosine prophylactically before stent placement or balloon dilation;while patents in another group were given 100 ug adenosine after stent placement if NRP happened.At the end of PPCI,the incidence of myocardial infarction thrombolysis test(TIMI)blood grading,myocardial TIMI perfusion grading(TMPG),myocardial staining grading(MBG)and NRP were examined.Results After stent placement,89.6%of patients in the prophylactic administration group had blood flow TIMI,TMPG and MBG grades of infarct-related vessels reaching grade 3,and 73.4%in the remedial administration group,with statistical significance(P<0.05).The incidence of NRP was 8.2%in the prophylactic group and the incidence was 23.6%in the remedial administration group,with statistical significance(P<0.05).TIMI,TMPG and MBG grade 3 blood flow were restored in all patients presented with NRP after intracoronary injection of adenosine.Conclusion For indicated patients with NSTEMI,prophylactical intracoronary injection of adenosine before stent implantation can reduce the incidence of NRP significantly after stent placement.