冠状动脉慢性完全闭塞病变介入术中应用多巴胺与去甲肾上腺素治疗低血压的效果比较  

Comparison of the effects of dopamine and norepinephrine on the treatment of hypotension during coronary chronic total occlusion intervention

作　　者：彭红玉[1] 李长江 何松原 程子超 吕媛[1] 柳景华[1] Peng Hongyu;Li Changjiang;He Songyuan;Cheng Zichao;Lyu Yuan;Liu Jinghua(The Fourth Ward,Coronary Heart Disease Center,Department of Cardiology,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心内科冠心病中心四病区,北京市心肺血管疾病研究所,北京100029

出　　处：《中国医药》2023年第8期1121-1125,共5页China Medicine

基　　金：国家自然科学基金(81970291);北京市属医院科研培育计划(PX2021026)。

摘　　要：目的比较冠状动脉慢性完全闭塞病变(CTO)介入术中应用多巴胺与去甲肾上腺素(NE)治疗低血压的效果。方法回顾性选取2020年1月至2022年9月于首都医科大学附属北京安贞医院住院接受CTO经皮冠状动脉介入术中发生低血压的患者62例,其中接受多巴胺治疗患者34例(DA组),接受NE治疗患者28例(NE组)。比较2组基线资料、手术资料、围手术期情况、不良反应及目标血管直径变化。结果2组患者年龄、性别、体重指数等基线资料以及血管入路、CTO病变特征、手术策略等手术资料比较,差异均无统计学意义(均P>0.05)。2组低血压可能病因比较差异无统计学意义(P>0.05)。DA组多巴胺使用最大剂量为(11.26±3.64)μg/(kg·min),NE组NE使用最大剂量为(0.09±0.03)μg/(kg·min),2组血管活性药物维持使用时间比较差异无统计学意义(P>0.05)。DA组出现窦性心动过速、消化道症状比例及用药前与药物治疗后的目标血管段直径差均高于/大于NE组[94.1%(32/34)比46.4%(13/28)、76.5%(26/34)比7.1%(2/28)、(0.52±0.22)mm比(0.29±0.13)mm](均P<0.001)。结论对于接受介入治疗的CTO患者术中发生的低血压,NE应作为首选的血管活性药物,而并非传统的多巴胺,因为前者的安全性及耐受性更佳。Objective To compare the effects of dopamine and norepinephrine(NE)on the treatment of hypotension during coronary chronic total occlusion(CTO)intervention.Methods From January 2020 to September 2022,62 patients who experienced hypotension during CTO percutaneous coronary intervention in Beijing Anzhen Hospital,Capital Medical University were selected retrospectively.Among them,34 patients received dopamine treatment(DA group)and 28 patients received NE treatment(NE group).The baseline data,surgical data,perioperative conditions,adverse reactions and changes in target vessel diameter in the two groups.Results There were no statistical differences in baseline data such as age,gender,body mass index and surgical data such as vascular approaches,CTO characteristics,surgical strategies in the two groups(all P>0.05).There was no statistically significant difference in the possible causes of hypotension in the two groups(P>0.05).The maximum dosage of dopamine used in the DA group was(11.26±3.64)μg/(kg·min),and the maximum dosage of NE used in the NE group was(0.09±0.03)μg/(kg·min).There was no statistically significant difference in the maintenance and use time of vasoactive drugs in the two groups(P>0.05).The proportions of sinus tachycardia and digestive symptoms and target vessel segment diameter differences before and after medication in the DA group were higher/greater than those in the NE group[94.1%(32/34)vs 46.4%(13/28),76.5%(26/34)vs 7.1%(2/28),(0.52±0.22)mm vs(0.29±0.13)mm](all P<0.001).Conclusion For CTO patients undergoing interventional therapy who experience intraoperative hypotension,NE should be the preferred vasoactive drug,rather than traditional dopamine,as the former has better safety and tolerance.

关 键 词：冠状动脉慢性闭塞病变 经皮冠状动脉介入 多巴胺 去甲肾上腺素 低血压 

分 类 号：R541.4[医药卫生—心血管疾病]