急性心肌梗死经皮冠脉介入术后无复流现象及654-2的干预  

Effect of intracoronary administration of 654-2 on "no reflow" phenomenon following primary PCI in the patients with AMI

作　　者：蔚永运[1] 傅向华[1] 刘君[1] 谷新顺[1] 吴伟力[1] 范卫泽[1] 姜云发[1] 薛玲[1] 张一达[1] 

机构地区：[1]河北医科大学第二医院心血管干部病房,河北石家庄050000

出　　处：《中国急救医学》2006年第2期95-98,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的评价冠状动脉内应用654-2对急性心肌梗死(AMI)经皮冠状动脉腔内成形术(PCI)后无复流现象的疗效及其安全性。方法21例AMI直接PCI后梗死相关动脉(IRA)存在无复流患者,男14例,女7例,年龄62.3±9.3岁。从症状开始至PCI术开通IRA时间7.14±2.32 h,术后平均TIMI血流1.76±0.43级,以硝酸甘油200μg冠状动脉内注入,10 min后以654-2 500μg冠状动脉内注入,于给药后第1、3、10分钟行冠状动脉造影(CAG)。应用TIMI血流计帧法和QCA分别测定硝酸甘油和654-2冠状动脉内给药后不同时间点的IRA血流速率帧数和管腔直径。结果①术后基础对照与硝酸甘油给药第1、3分钟时CAG血流帧数变化比较差异无显著性(83.80±9.40 vs 78.33±10.39帧、83.80±9.40 vs 77.47±10.51帧,P均>0.05);654-2给药后第1、3和10分钟时CAG血流帧数分别较给药前减少58.3%、56.2%和54.6%(P均<0.001);②冠状动脉内给予654-2后3 min时IRA管径亦较前略有增加(3.20±0.26 mm vs 3.30±0.25 mm,P>0.05);③654-2冠状动脉内给药后10 min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显著性(P>0.05)。结论冠状动脉内应用654-2 500μg可改善AMI直接PCI术后无复流现象,且安全易行,可作为治疗IRA开通后无复流现象的有效药物之一。Objective To assess the efficacy and safety of intraeoronary administration of 654 - 2 on ＂no reflow＂ phenomenon following primary PCI in patients with AMl.Methods Twenty-one patients （male 14, female 7.62.3 ± 9.3 years old） with AMI who had been successfully performed primary PCI were found ＂no reflow＂ phenomenon. PCI was successfully pertbrmed about 7.14 ± 2.32 hours after the onset of angina pectoris（AP）. The mean TIMI blood flow grade was about （1.76 ± 0.43） after PCI. Nitroglycerin （200 μg） was injected into coronary artery. 654 - 2 （500 μg） was injected into coronary ＂artery after 10 minutes. Coronary angiography has been finished in 1, 3, 10 minutes after administration of the two medicines respectively. All the data were analysed＇by Gibson＇ s TIMI frame count method and quantitative computer angiography （ QCA ） system. Results ① No significant change was found at I st or 3rd rain ＂after intraeoronary administration of nitroglycerin （ P 〉 0.05） ; TIMI frames count was decreased by 58.3%, 56.2% and 54.6% at 1st, 3rd, 10th min respeetively after intracoronary administration of 654 - 2. ②The diameter of middle segment of reopened coronary artery was increased from 3.20 ± 0.26 mm to 3.30 ± 0.25 mm at 3rd rain after intracororonary administration of 654- 2 （P 〉 0.05）. ③During and after intracoronary achninistration of 654-2, blood pressure, PR interval, QT interval and QRS duration didn＇t find any significant changes（ P 〉 0.05）. Conchlsions lntracoronary administration of 654- 2 500 ttg proved to be safe and easy clinically, and improved ＂no reflow＂ phenomenon following primary PCI in the patients with AMI, and might be one of the first choice in medical therapy for ＂no reflow＂ phenomenon.

关 键 词：心肌梗死 654—2 经皮腔内冠脉成形术 无复流 

分 类 号：R542.22[医药卫生—心血管疾病]