冠状动脉内注射阿托品与保护性临时起搏对急性下壁心肌梗死急诊介入时再灌注心律失常的疗效比较研究  

Intracoronary Injection of Atropine versus Temporary Cardiac Pacing for Preventing and Treating Reperfusion Arrhythmia in Emergency PCI for Acute Inferior Myocardial Infarction

作　　者：田克钧[1] 钟玉婷[2] 钟一鸣[1] 王小萍[1] 周爱琴[1] TIAN Kejun;ZHONG Yuting;ZHONG Yiming;WANG Xiaoping;ZHOU Aiqin(Cardiovascular Department,First Affiliated Hospital of Gannan Medical University,Ganzhou 341000,China;Department of Anesthesiology,First Affiliated Hospital of Gannan Medical University,Ganzhou 341000,China)

机构地区：[1]赣南医学院第一附属医院心内科,江西省赣州市341000 [2]赣南医学院第一附属医院麻醉科,江西省赣州市341000

出　　处：《中国全科医学》2019年第29期3544-3548,共5页Chinese General Practice

摘　　要：背景急性下壁心肌梗死急诊介入治疗中常植入保护性临时起搏或静脉注射阿托品来防治再灌注心律失常,但上述2种方法均有较多缺陷。目前赣南医学院第一附属医院不常规植入临时起搏器及静脉注射阿托品,而是通过冠状动脉内注射小剂量阿托品治疗再灌注心律失常,发现该方法效果较好,患者获益较大。而国内目前尚未见冠状动脉内注射阿托品及术中保护性临时起搏防治再灌注心律失常的相关对比研究。目的比较冠状动脉内注射阿托品与临时起搏器植入对急性下壁心肌梗死急诊介入时再灌注心律失常的疗效。方法选取2012年2月-2018年9月赣南医学院第一附属医院心内科收治行急诊经皮冠状动脉介入治疗(PCI)术的急性下壁心肌梗死患者122例为研究对象。采用随机数字表法分为阿托品治疗组、临时起搏器植入组,4例患者术中冠状动脉内注射阿托品无反应而紧急行临时起搏器植入,10例患者术中未发生再灌注心律失常,未行阿托品及临时起搏心率干预,最终阿托品治疗组纳入58例,临时起搏器植入组纳入50例。记录阿托品冠状动脉内注射后起效时间(心室率>60次/min),临时起搏器植入所需时间,穿刺-球囊扩张时间,人均住院天数、费用,术前及术中平均动脉压、缓慢性心律失常、恶性室性心律失常发生情况,术中及术后以多巴胺10μg·kg^-1·min^-1以上维持循环情况,并比较两组间有无差异。结果阿托品治疗组患者阿托品冠状动脉内注射后起效时间为(11±5)s,少于临时起搏器植入组患者临时起搏器植入所需时间(360±120)s(t=20.54,P<0.001)。阿托品治疗组穿刺-球囊扩张时间、人均住院天数、人均住院费用均少于临时起搏器植入组(P<0.05)。术中阿托品治疗组平均动脉压、恶性室性心律失常发生率低于临时起搏器植入组,缓慢性心律失常发生率高于临时起搏器植入组(P<0.05)。结�Background In emergency PCI for acute inferior myocardial infarction(AIMI),to prevent and treat the arrhythmia after reperfusion,temporary cardiac pacing or intravenous injection of atropine is often used.But both two methods have insufficiencies.In contrast,intracoronary injection of a small dose of atropine has been found with a remarkable effectiveness and great benefits by First Affiliated Hospital of Gannan Medical University.However,there is no comparative study of intracoronary injection of atropine and intraoperative temporary cardiac pacing for preventing and treating arrhythmia after reperfusion in China.Objective To compare the efficacy of intracoronary injection of atropine and temporary pacemaker implantation for reperfusion arrhythmia in emergency PCI for AIMI.Methods 122 cases of AIMI who underwent emergency PCI from February 2012 to September 2018 in Cardiovascular Department,First Affiliated Hospital of Gannan Medical University were enrolled.14 cases of them were excluded from intergroup comparison because during the operation,4 received emergency temporary pacemaker implantation due to lack of response to intracoronary injection of atropine,and 10 without bradyarrhythmia following reperfusion did not need to receive the aforementioned two interventions,and the remaining 108 cases were randomized into intracoronary injection of atropine group(n=58),and pre-PCI temporary pacemaker implantation group(n=50).Onset time of atropine after intracoronary injection(effectiveness criterion:ventricular rate>60 beats/min),time used for temporary pacemaker implantation,and puncture-balloon dilation time,average hospital stay and cost,preoperative and intraoperative average arterial pressure,incidence of bradyarrhythmia,malignant ventricular arrhythmia,maintenance of circulation with dopamine above 10 μg·kg-1·min-1 during and after operation were collected.Results The average onset time of atropine after intracoronary injection in the intracoronary injection of atropine group was(11±5)s,which was less tha

关 键 词：下壁心肌梗死 心律失常 心动过缓 阿托品 生物钟 血管成形术 气囊 冠状动脉 冠状血管 

分 类 号：R542.22[医药卫生—心血管疾病]