右冠状动脉右心室支与急性右心室心肌梗死患者血流动力学变化的相关性研究  

Relationship between right ventricular branch of right coronary artery and hemodynamics in patients with acute right ventricular myocardial infarction

作　　者：冯斯婷[1] 艾辉[1] 郝鹏[1] 索旻[1] 白杉 范婧尧 王溪[1] 聂绍平[1] FENG Siting;AI Hui;HAO Peng;SUO Min;BAI Shan;FAN Jingyao;WANG Xi;NIE Shaoping(Department of Emergency and Critical Care Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所急诊危重症中心,100029

出　　处：《心肺血管病杂志》2021年第8期790-794,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家科学技术部国家重点研发计划项目(2019YFC2004800)。

摘　　要：目的:右冠状动脉右心室支为维持右心室功能的重要血管,本研究旨在评估右冠状动脉血运重建后右心室支受累与右心室心肌梗死(RVMI)早期血流动力学变化的相关性。方法:本研究采用临床病历资料回顾的方法入选2011年8月至2020年1月,就诊北京安贞医院急诊危重症中心急诊综合病房的急性下RVMI患者111例。根据患者冠状动脉造影影像资料中右心室支血运重建前后的TIMI血流分级,将患者分为术前术后右心室支血流均正常组(正常组)、术后右心室支血流改善组(改善组)和术后右心室支血流无改善或恶化组(受累组),比较三组间血运重建术后0、6及24 h血流动力学变化的差异。结果:RVMI患者的罪犯血管均为右冠状动脉(RCA),梗死相关病变部位在正常组主要为中段(64.5%)、改善组为近段(76.7%),而受累组病变部位无特异性。血运重建前,受累组异丙肾上腺素/阿托品/临时起搏器的使用比例最高(P=0.001)。右冠状动脉成功血运重建后,正常组和改善组血流动力学分别在术后0和24 h趋于稳定,受累组血流动力学受损程度更明显、且恢复速度更慢,24 h仍有更高比例的0.9%氯化钠溶液维持血压、药物和器械稳定心率/心律。结论:急性RVMI患者即使RCA主干成功血运重建,右心室支受累仍与早期右心功能受损的血流动力变化如低血压和缓慢型心律失常密切相关。血运重建术中加强对右心室支的关注和保护可能有助于稳定急性期血流动力学和促进右心功能恢复。Objective: The right ventricular(RV) branch of the right coronary artery is an important vessel to maintain the right ventricular function, the objective of this study was to evaluate the relationship between RV branch and early hemodynamic changes in right ventricular myocardial infarction(RVMI) after RCA revascularization. Methods: In this study, 111 patients with acute inferior RVMI who were admitted to the emergency comprehensive ward of the Emergency and Critical Care Center of Beijing Anzhen Hospital from August 2011 to January 2020 were retrospectively collected. According to the TIMI blood flow grading of RV branch before and after revascularization, the patients were divided into three groups: group with normal RV branch flow before and after intervention(normal group), group with improved RV branch flow after intervention(improved group), and group with no improved or deteriorated RV branch flow after intervention group(affected group), The hemodynamic changes at 0 h, 6 h and 24 h after revascularization were compared among the three groups. Results: All patients with RVMI had RCA as the culprit vessel, the infarction-related lesion site in the normal group was mainly in the middle(64.5%), while the improvement group was mainly in the proximal(76.7%), while there was no specific site in the affected group. Before revascularization, the use of isoproterenol/atropine/temporary pacemaker was the highest in the affected group(P=0.001). After revascularization, the hemodynamics of the normal group and the improved group tended to be stable at 0 h and 24 h after intervention, respectively. The hemodynamics decompensation in the affected group was more obvious, and the recovery was slower, and there was still a higher saline injection to maintain blood pressure, medications and equipment to stabilize heart rate/rhythm for 24 h. Conclusions: Even if RCA trunk revascularization is successful in patients with acute RVMI, RV branch is still closely associated with hemodynamic changes such as hypotension and slow a

关 键 词：急性右心室心肌梗死 右心室支 血流动力学 

分 类 号：R54[医药卫生—心血管疾病]