冠状动脉内快速注射硝普钠对急性心肌梗死患者急诊冠状动脉介入治疗中无再流的作用  

Effects of Intracoronary administration of nitroprusside on no-reflow phenomenon during emergency percutaneous coronary Intervention in patients with acute myocardial infarction

作　　者：苗立夫 杨冬[2] 黄超联 白书玲 刘云宝 曾玉杰 李群 王丽宁 孙晓艳 陆爱民 

机构地区：[1]清华大学第一附属医院心脏中心,北京100016 [2]中日友好医院心内科 [3]山东省胶州市中心医院

出　　处：《临床心血管病杂志》2008年第10期765-769,共5页Journal of Clinical Cardiology

基　　金：清华-裕元医学科学研究基金(No:20240000556,20240000520)

摘　　要：目的:评价冠状动脉内应用硝普钠对急性心肌梗死(AMI)患者急诊经皮冠状动脉介入(PCI)治疗中梗死相关动脉(IRA)无再流现象的疗效。方法:AMI急诊PCI后再通的IRA存在无再流现象者32例。11例患者(尿激酶组)冠状动脉内注射尿激酶20×104U;21例患者(硝普钠组)于冠状动脉内注射硝普钠200μg,2 s内"弹丸式"快速注射完毕。10 min后复查冠状动脉造影,评定冠状动脉血流TI MI分级及校正TI MI帧数(cTFC)。结果:尿激酶组用药前后cTFC帧数分别为(73.87±10.76)和(73.16±11.45)帧,差异无统计学意义(P>0.05)。硝普钠组用药后80.95%患者梗死相关血管IRA血流恢复TI MI 3级,cTFC帧数由用药前的(76.15±12.92)帧降至(27.29±9.13)帧,差异有统计学意义(P<0.01)。硝普钠组用药后出现一过性低血压状态者4例。尿激酶组出现股动脉血肿及致死性消化道出血各1例。结论:经冠状动脉内快速注射硝普钠200μg能有效改善AMI急诊PCI中无再流现象。Objective： To assess the effects of intracoronary bolus injection of nitroprusside on no-reflow phenomenon of infarct-related artery （IRA） during emergent percutaneous coronary intervention in the patients with acute myocardial infarction （AMI）. Method： Tirty-two patients with no-reflow phenomenon from a total of 247 AMI patients accepted emergency PCI were enrolled into this study from March 2005 to Augest 2007. Urokinase treated group （n= 11） was given intracoronary urokinase 200 000 units within 5 minutes while nitroprusside treated group （n= 21） was given intracoronary bolus injection with nitroprusside 200 μg within 2 seconds. The corrected TIMI frame count （cTFC）, thrombolysis in myocardial infarction （TIMI） flow grade were calculated and analyzed by Gibson＇s TIMI frame count method using quantitative computer angiography （QCA） system to evaluate the influence of nitroprusside on coronary flow of IRA. Resuit：No significant changes in cTFCs and TIMI flow grade were found after intracoronary administration of urokinase as compared with the baseline control （P〉0.05）. A 200 μg dose of nitroprusside administrated restored TIMI flow of grade 3 in 80. 95% of patients （17 of 21） in nitroprusside-treated group, cTFCs of IRA were decreased from 76.15±12. 92 to 27. 29±9. 13 （P〈0. 001） after intracoronary administration of nitroprusside. Conclusion： Intracoronary bolus injection with nitroprusside 200 μg is an effective and safe treatment of no-reflow phenomenon associated with emergency PCI in AMI.

关 键 词：心肌梗死 硝普钠 尿激酶 经皮冠状动脉介入术 无再流现象 

分 类 号：R542.2[医药卫生—心血管疾病]