应用D-SPECT评估远程缺血预适应联合腺苷注射液在PCI患者中的作用  

Evaluation of the effect of remote ischemic preconditioning combined with adenosine injection in patients undergoing PCI using D-SPECT

作　　者：李柳[1] 李敏[1] 郑庆厚[1] 李晓燕[1] 赵甫刚[1] 王硕 LI Liu;LI Min;ZHENG Qinghou;LI Xiaoyan;ZHAO Fugang;WANG Shuo(Department of Cardiology,Hebei Medical University First Hospital,Shijiazhuang 050011,China;Department of Cardiology,Shijiazhuang People’s Hospital,Shijiazhuang 050031,China)

机构地区：[1]河北医科大学第一医院心内科,石家庄050011 [2]石家庄市人民医院心内科,石家庄050031

出　　处：《中国医科大学学报》2024年第8期725-730,共6页Journal of China Medical University

基　　金：河北省中医药管理局科研计划(2023322)。

摘　　要：目的应用D-SPECT评价远程缺血预适应联合腺苷注射液在经皮冠状动脉介入治疗(PCI)患者中的作用。方法选择需行冠状动脉造影术及支架植入术患者300例,按照随机数字表法分为常规治疗组(150例)和试验组(150例),常规治疗组给予冠状动脉粥样硬化性心脏病PCI术常规治疗,试验组在PCI术当日通过血压计袖带分别在左、右上臂充气至200 mmHg,持续加压5 min诱导2次远程缺血预适应,然后在患者PCI术中以50μg/(kg·min)泵入腺苷注射液至术毕,其他治疗同常规治疗组,并对所有患者进行冠状动脉SYNTAXⅡ评分。应用静息D-SPECT+瑞加诺生负荷D-SPECT评估PCI术前及PCI术后7 d的心肌17节段分布下心肌灌注总积分、心肌缺血总节段数和左心室射血分数情况。结果PCI术前2组患者心肌缺血节段数、心肌灌注总积分、左心室射血分数情况差异无统计学意义(P>0.05),PCI术后7 d试验组的心肌缺血节段数、心肌灌注总积分、左心室射血分数情况显著优于常规治疗组(P<0.05),2组患者在药物不良反应方面差异无统计学意义(P>0.05)。结论远程缺血预适应联合腺苷注射液在PCI患者中应用安全有效。Objective This study utilized regadenoson stress D-SPECT to evaluate the impact of remote ischemic precondi-tioning combined with adenosine injection in patients undergoing percutaneous coronary intervention(PCI)using D-SPECT imaging.Methods Three hundred patients requiring coronary angiography and stent implantation were randomly assigned into two groups utilizing the random number table method.The conventional treatment group(150 patients)and the experimental group(150 patients)received standard treatment for coronary heart disease PCI.The experimental group underwent two sessions of remote ischemic precon-ditioning on the day of PCI,wherein the left and right upper arms were inflated to 200 mmHg with continuous pressure for 5 minutes using a blood pressure cuff.Additionally,during the PCI procedure,adenosine was administered to the experimental group at a rate of 50μg/(kg·min)until the end of the procedure,with other treatments aligning with the conventional treatment group.Each patient received a coronary SYNTAXⅡscore.Resting D-SPECT and regadenoson stress D-SPECT were employed to evaluate total myocardial perfusion score,total myocardial ischemia segments,and left ventricular ejection fraction across 17 segment distributions before and 7 days after PCI.Results Before PCI,the differences in the number of myocardial ischemic segments,total myocardial perfusion score,and left ven-tricular ejection fraction between the two patient groups were not statistically significant(P>0.05).However,7 days post-PCI,compared with the conventional treatment group,the experimental group exhibited significantly improved numbers of myocardial ischemic segments,total myocardial perfusion score,and left ventricular ejection fraction(P<0.05).Furthermore,the differences in adverse drug reactions between the two patient groups were not statistically significant(P>0.05).Conclusion The combined application of remote ischemic preconditioning and adenosine injection in patients undergoing PCI is deemed safe and effective.

关 键 词：缺血预适应 腺苷注射液 瑞加诺生 D-SPECT 

分 类 号：R541.4[医药卫生—心血管疾病]