三磷酸腺苷和腺苷在诊断房室结双径路现象时剂量比较初探

Dose Relation Between ATP and Adenosine in Diagnosis of Dual Atrioventricular Nodal Pathways

目的 :研究窦性心律时静脉注射三磷酸腺苷 (ATP)或腺苷诱发房室结双径路现象的最小有效剂量。同时比较ATP和腺苷的剂量相关性。方法 :窦性心律下 ,42例患者经外周静脉快速注射ATP和腺苷 ,诱发房室结双径路现象 (相邻 2个心搏之间 ,PR间期时限增加或者减少≥ 5 0ms ,出现 1个以上的房室结回波 )或者出现Ⅱ度以上的房室传导阻滞。ATP的起始剂量为10mg ,递增量为 5mg ;腺苷的起始剂量为 6mg ,递增量为 3mg。 42例患者分成 2组 :试验组 (n =2 2 )为心内电生理检查明确为慢—快型房室结双径路折返性心动过速患者 ,对照组 (n =2 0 )为非慢—快型房室结折返性心动过速患者。结果 :在试验组中静脉注射ATP或腺苷 ,2 0例患者出现房室结双径路现象。对照组中 2例出现房室结双径路现象。该试验的特异性为 91% ,敏感性为 90 %。诱发房室结双径路现象时ATP最小剂量为 10mg ,最大剂量为 2 0mg ,平均有效剂量为 ( 15 0 0± 4 2 9)mg。腺苷的最小剂量为 6mg ,最大剂量为 18mg ,平均有效剂量为 ( 9 75± 3 62 )mg。诱发房室结双径路现象时ATP和腺苷剂量呈显著相关性 ,但ATP和腺苷剂量与年龄体重没有相关性。结论 :在窦性心律时外周静脉注射ATP和腺苷可以鉴别房室结双径路现象 。

Objective:To study the minimal effective doses of intravenous ATP and adenosine required to induce dual atrioventricular nodal pathways (DAVNP) during sinus rh ythm. The inducible doses and correlation of ATP with adenosine were investigate d. Methods:Our study included 42 patients. A rapid bolus of ATP (10 to 20 mg, at 5 mg increments) or adenosine (6 to 18 mg, at 3 mg increments) was administer ed u ntil signs of DAVNP (≥50 ms increase or decrease in PR interval in consecutive beats, or occurrence of ≥1 AV nodal echo beat) or≥second degree AV block, wer e observed. Forty-two patients were classified into two groups, study group and control group. The study group included 22 patients who were proven to have typ ical atrioventricnlar nodal reentrant tachycardia (AVNRT) in electrophysiology ( EP) s tudy. The control group included 20 patients who were proven to have no AVNRT. Results:DAVNP by ATP or adenosine testing were successfully observed in 20 pati ents in the study group and 2 patients in the control group. The specificity wa s 91%, and the sensitivity was 90%. The minimal effective doses of ATP was 10 mg , and the maximum was 20 mg. Effective doses of ATP were 15.00±4.29 mg. The m inimal effective dose of adenosine was 6 mg, and the maximum was 18 mg. Effectiv e doses of adenosine were 9.75±3.62 mg. There was a study found close correla tion between ATP and adenosine and no correlation between effective doses and w eight or age. Conclusion: Administration of ATP and adenosine during sinus rhythm can identify DAVNP. Our resalts provide a minimal and incremental approach to identify this phenomenon. There is a close correlation between ATP and adenosine.