迷走神经反射在下后壁STEMI再灌注损伤中的作用  

Effect of vagus reflex on reperfusion injury during percutaneous coronary intervention with acute inferior or posterior myocardial infarction

作　　者：蒋桔泉[1] 丁世芳[1] 陈志楠[1] 卢青[1] 龚志刚[1] 李志刚[1] 付文波[1] 彭毅[1] 王仁学[1] 

机构地区：[1]广州军区武汉总医院心内科,武汉430070

出　　处：《临床心血管病杂志》2014年第9期782-784,共3页Journal of Clinical Cardiology

摘　　要：目的:探讨迷走神经反射在急性下壁、后壁ST抬高型心肌梗死(STEMI)急诊冠状动脉(冠脉)介入治疗(PCI)再灌注损伤的作用。方法:147例冠脉造影显示急性右冠脉闭塞致急性下壁、后壁心肌梗死患者,分为阿托品预防组(76例)和对照组(71例),阿托品预防组冠脉开通前给予小剂量阿托品0.5mg静脉注射,对照组不给予阿托品干预,观察两组再灌注心律失常、低血压、慢血流、无复流发生情况。结果:阿托品预防组发生再灌注心律失常34例,其中快速心律失常18例,缓慢心律失常16例,低血压22例,慢血流5例,对照组发生再灌注心律失常50例,其中快速心律失常17例,缓慢心律失常33例,低血压32例,慢血流9例,无复流2例,两组缓慢性心律失常和低血压发生率有显著差异(P<0.05),而两组快速心律失常发生率无统计学差异。结论:迷走神经反射在急性下壁、后壁心肌梗死再灌注损伤中起重要作用,急诊开通冠脉前,给予小剂量阿托品拮抗迷走神经反射,可以减少再灌注引起的缓慢性心律失常及低血压的发生,增加手术平稳性,值得临床推广。Objective：To study the effect of vagus reflex on reperfusion injury during percutaneous coronary in tervention（PCI） with acute inferior or posterior myocardial infarction. Method： One hundred and forty-seven pa- tients with acute inferior or posterior myocardial infarction related with right coronary artery treated by PCI within 12 hours, were divided into the atropine treatment group and the control group. In the atropine treatment group, 76 cases were intravenously injected atropine 0.5 mg before opening the coronary artery, and in the control group 71 cases were not treated with atropine. It was compared that the incidences of reperfusion arrhythmia（RA）, hy- potension, slow blood flow, no flow after PC1 between the two groups. Result：There were 34 cases of reperfusion arrhythmia, including 18 cases of tachyarrhythmia, 16 cases of bradyarrhythmia, 22 cases of hypotension, 5 cases of slow flow after percutaneous coronary intervention in the atropine treatment group. There were 50 cases of reperfusion arrhythmia, including 17 cases of tachyarrhythmia, 33 cases of bradyarrhythmia, 32 cases of hypoten- sion, 9 cases of slow flow, 2 cases of no reflow after pereutaneous coronary intervention in the control group. The incidence of bradyarrhythmias and hopertension after PCI were significant higher in the control group than those in atropine treatment group（P〈0.05） ,but the incidence of tachyarrhythmias was not significant difference between two groups（P〉0.05）. Conclusion： Vagus reflex plays an important role on reperfusion injury in acute right myo- cardial infarction. It can reduce the reperfusion bradyarrhythmias and hopertension that intravenous injection atro- pine before opening the coronary artery during PCI with acute right coronary infarction. It is worthy of clinical promotion.

关 键 词：迷走神经反射 急性下壁、后壁心肌梗死 再灌注损伤 阿托品 经皮冠状动脉介入治疗 

分 类 号：R542.2[医药卫生—心血管疾病]