硝普钠联合肾上腺素治疗急性心肌梗死急诊经皮冠状动脉介入术中无复流的疗效观察  

Observation on the effect of sodium nitroprusside combined with epinephrine for the treatment of acute myocardial infarction patients with no-reflow phenomenon during percutaneous coronary intervention

作　　者：白宝宝 郭万刚[1] 陈蕊蕊 曾广伟 周海佳 王芳芳[1] Bai Baobao;Guo Wangang;Chen Ruirui;Zeng Guangwei;Zhou Haijia;Wang Fangfang(Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi an 710038, China)

机构地区：[1]中国人民解放军空军军医大学唐都医院心内科,西安710038

出　　处：《中国心血管杂志》2018年第6期446-449,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的研究硝普钠联合肾上腺素对急性心肌梗死患者急诊经皮冠状动脉介入(PCI)术中无复流及预后的影响。方法选取2016年1月至2017年6月在空军军医大学唐都医院心内科就诊的急性ST段抬高型心肌梗死急诊PCI术中出现无复流的患者58例,按随机数字表法分为治疗组28例和对照组30例。在出现无复流后,治疗组冠状动脉内给予硝普钠联合肾上腺素,对照组仅给予硝普钠。对比用药前后两组TIMI血流分级及校正TIMI帧数(CTFC),记录两组血压、心率变化及心律失常发生情况,比较两组住院期间不良心血管事件发生情况。结果术中出现无复流给药后5 min,治疗组TIMI血流3级及CTFC值均明显优于对照组(均为P <0. 05);对照组发生窦性心动过缓及低血压的比例高于治疗组(均为P <0. 05);住院期间治疗组患者的不良心血管事件发生率低于对照组(14. 3%比40. 0%,P=0. 028)。结论冠状动脉内注射硝普钠联合肾上腺素能明显改善急性心肌梗死患者急诊PCI术中的无复流现象,并降低住院期间不良心血管事件的发生。Objective To investigate the clinical effect of sodium nitroprusside combined with epinephrine on no-reflow and prognosis in patients with acute myocardial infarction (AMI) undergoing emergency percutaneous coronary intervention (PCI).Methods A total of 58 acute ST elevation myocardial infarction patients, who suffered from no-reflow during PCI in our department from Jan 2016 to Jun 2017, were selected. Patients were randomly divided into treatment group (28 cases, intravenous injection of sodium nitroprusside combined with epinephrine when no reflow occurred) and control group (30 cases, intravenous injection of sodium nitroprusside when no reflow occurred). The angiographic results including thrombolyses in myocardial infarction (TIMI) and corrected TIMI frame count (CTFC) was assessed. The blood pressure, heart rate and arrhythmia during PCI were recorded. The incidence of adverse cardiovascular events in the two groups during hospitalization was compared between the two groups. Results Five minutes after no-reflow, the treatment group had a higher rank of TIMI and lower value of CTFC ( P<0.05). The occurrence of sinus bradycardia and hypotension in the control group was significantly higher than that in the treatment group ( P<0.05). The incidence of adverse cardiovascular events in the treatment group was lower than that in the control group during hospitalization (14.3% vs. 40.0%, P=0.028). Conclusions Intracoronary injection of sodium nitroprusside combined with epinephrine can effectively alleviate the no reflow phenomenon and reduce the incidence of adverse cardiovascular events during hospitalization.

关 键 词：急性心肌梗死 无复流现象 硝普钠 肾上腺素 

分 类 号：R542.22[医药卫生—心血管疾病]