冠状动脉内注射山莨菪碱对急性心肌梗死经皮冠脉介入术后缓再血流现象的影响

Effect of Intra-coronary Injection of Anisodamine on the Slow-reflow Phenomenon in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention

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中文关键词: 山莨菪碱心肌梗死经皮腔内冠状动脉成形术缓再血流

英文关键词:anisodamine myocardial infarction percutaneous transluminal coronary angioplasty slow-reflow phenomenon

基金项目:

作者	单位
蔚永运	中国人民武装警察部队医学院附属医院脑系科
傅向华	河北医科大学第二医院干部病房
刘君	河北医科大学第二医院干部病房
苗青	河北医科大学第二医院干部病房

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中文摘要:

目的评价冠状动脉内应用山莨菪碱对急性心肌梗死(AMI)患者经皮冠状动脉腔内成形和支架术(PTCA/STENT)后缓再血流现象的影响及其安全性。方法153例AMI直接经皮冠状动脉介入治疗(PCI)后再通的梗死相关动脉(infarction related artery,IRA)存在缓再血流患者25例,男17例,女8例,年龄(62·3±9·3)岁。其中前降支10例,回旋支5例,右冠状动脉10例。从症状开始至PCI术开通IRA时间(7·11±2·31)h,术后平均完全闭塞病变(TIMI)血流(1·75±0·42)级,先以硝酸甘油200μg冠脉内注入(确认slow refow现象)作为对照,10min后继以山莨菪碱500μg(2min)冠脉内注入,于给药后第1、3、10min行冠状动脉造影(CAG)。应用Gibson的TIMI血流计帧法和QCA测量系统分别行硝酸甘油和山莨菪碱冠状动脉内给药后不同时间点IRA再通后血流速率帧数和管腔直径的定量分析、血流动力学及心电图变化。结果(1)术后(用药前)与硝酸甘油给药1min时CAG血流帧数分别为(82·79±9·30)帧和(78·43±9·37)帧,但差异无统计学意义(P>0·05);山莨菪碱给药后第1、3、10min时CAG血流帧数(帧)分别较给药前减少为46·25±4·55、44·52±4·32、43·09±4·18,差异有统计学意义(P<0·01),平均TIMI血流从(1·75±0·42)级增加到(2·70±0·45)级,差异有统计学意义(t=0·34,P<0·05);(2)冠状动脉内给予山莨菪碱后3min时开通IRA中段管径亦较前略有增加〔分别为(3·2±0·3)mm、(3·3±0·4)mm〕,差异无统计学意义(P>0·05);(3)山莨菪碱冠状动脉内给药后10min内连续监测冠状动脉内压、外周血压、PR间期、QT间期和QRS时限各参数与给药前比较,差异均无统计学意义(P>0·05)。心率较用药前增加了15~19次/min,但未引起严重的心动过速和心律失常。结论冠状动脉内应用山莨菪碱500μg可改善AMI直接PCI术后缓再血流现象,且安全易行,可作为治疗IRA开通后缓再血流现象的有效药物之一。

英文摘要:

ObjectiveTo assess the effect and safety of intra-coronary administration of anisodamine on "slow-reflow" phenomenon of infarct related artery (IRA) following primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). MethodsTwenty-five patients with slow-reflow phenomenon screened out from 153 AMI patient with post-PCI reflow IRA were enrolled. They were 17 males and 8 females; aged (62.3±9.3) years; 10 with focal artery at left anterior descendens, 5 in circumflux and 10 in right coronary artery; PCI was successfully performed on them about 7.11±2.31 h after the onset of angina pectoris and the post-operation mean TIMI flow was 1.75±0.42 grade. Nitroglycerin (200 μg) was injected into coronary previously for confirming the slow-reflow phenomenon as control, then the injection of anisodamine 500 μg 10 min later. Coronary arteriography (CAG) was performed at the 1 st, 3 rd and 10 th min after the medication. Gibson’s TIMI frame count method and quantitative computer angiography (QCA) system was used to quantitatively detect the frames of blood flow and the diameter of arterial lumen at different time points after nitroglycerin or anisodamine administration. Hemodynamics and changes of electrocardiogram were determined. Results(1) No significant change in frames of blood flow was found between before and 1 min after intra-coronary administration of nitroglycerin (82.79±9.30 frames vs 78.43±9.37 frames, P>0.05) after operation; but 1, 3 and 10 min after injection of anisodamine, it was decreased 46.25±4.55, 44.52±4.52 and 43.09±4.18, respectively, all P<0.01, and the average coronary blood flow increased from TIMI grade 1.75±0.42 to grade 2.70±0.45 (t=0.34,P<0.05). (2) The diameter of middle segment of reopened coronary artery slightly increased from 3.2±0.3 mm to 3.3±0.4 mm 3 min after anisodamine injection, but without statistical significance (P>0.05). (3) Successive monitoring at 10 min after anisodamine injection showed that all the parameters, including intra-coronary pressure, peripheral blood pressure, P-R interval, Q-T interval and QRS duration were not changed significantly (P>0.05), only the heart rate increased for 15-19 beats/min, but did not induce tachycardia or other malignant arrhythmia. Conclusion Intra-coronary administration of anisodamine 500 μg could improve the post-PCI slow-reflow phenomenon, it is safe and convenient, and may be taken as an effective approach for treatment of the illness.

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