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超选择性冠脉内注射硝普钠对急性心肌梗死急诊冠状动脉介入治疗中无再流现象的作用

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2010年第4期
页码:
572-575
栏目:
临床研究
出版日期:
2010-06-10

文章信息/Info

Title:
No-reflow phenomenon in primary percutaneous coronary intervention of acute myocardial infarction: effect of super-selective intracoronary injection of nitroprusside
作者:
孙家安; 汝磊生; 李俊峡; 彭育红; 徐若华; 杨莉; 梅静
解放军白求恩国际和平医院心内科，河北 石家庄 050082
Author(s):
SUN Jia-an;  RU Lei-sheng;  LI Jun-xia;  PENG Yu-hong;  XU Ruo-hua;  YANG li;  MEI Jing
Department of Cardiology, Bethune International Peace Hospital, Shijiazhuang 050082, Hebei, China
关键词:
心肌梗死; 硝普钠; 经皮冠状动脉介入术; 无再流现象; 血栓抽吸装置
Keywords:
acute myocardial infarction;  nitroprusside;  percutaneous coronary intervention;  no-reflow phenomenon;  thrombus aspiration catheter
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的: 评价超选择性冠状动脉内注射硝普钠对急性心肌梗死(AMI)患者急诊经皮冠状动脉介入(PCI)治疗中梗死相关动脉(IRA)无复流现象的作用。方法: 选择AMI急诊PCI后再通的IRA存在无复流现象者43例。21例患者经血栓抽吸导管超选择性梗死相关冠状动脉内注射法，22例患者采用常规指引导管内注射方法。药物均采用硝普钠100 μg,2 s内“弹丸式”快速注射完毕。10 min后复查冠状动脉造影,评定冠状动脉血流TIMI分级及校正TIMI 帧数(cTFC)。结果: 两组均可明显改善急诊PCI后的无再流现象，超选择组所有患者梗死相关血管IRA血流恢复TIMI Ⅲ级,cTFC帧数由用药前的(84±7)帧降至(26±6)帧,与常规组相比较差异有统计学意义(P<0.01)。结论: 超选择性IRA内快速注射硝普钠100 μg能更有效地改善AMI急诊PCI中无再流现象。
Abstract:
AIM: To evaluate the effect of super-selective intracoronary injection of nitroprusside on no-reflow phenomenon of primary percutaneous coronary intervention (PCI). METHODS: Forty-three acute myocardial infarction (AMI) patients with no-reflow phenomenon after primary PCI were included in the study. Super-selective intracoronary infarction related artery (IRA) injection from ZEEK thrombus aspiration catheters was used in 21 cases, and routine injection from guiding catheter was used in the other 22 cases. Nitroprusside was injected (100 μg) by 2-sec bolus in both groups. Coronary arteriography (CAG) was rechecked 10 min after injection, and TIMI as well as CTFC of IRA blood flow were evaluated. RESULTS: No-reflow phenomenon was markedly relieved in both groups. All cases in the super-selective group restored TIMI III blood flow and CTFCs of IRA decreased from 83.7±7.02 to 26.5±5.81 (P<0.001) after super-selective intracoronary injection of nitroprusside, whereas those in the routine group decreased from 84.5±6.45 to 33.8±11.9, with significant difference in IRA TIMI and CTFC between groups (P<0.01). CONCLUSION: Super-selective injection of 100 μg nitroprusside in IRA effectively improved no-reflow phenomenon in primary PCI of AMI.

参考文献/References

［1］Romano M, Buffoli F, Tomasi L, et al. The no-reflow phenomenon in acute myocardial infarction after primary angioplasty: incidence, predictive factors, and long-term outcomes［J］. J Cardiovasc Med, 2008, 9(1):59-63.

［2］Falk E, Thuesen L. Pathology of coronary microembolisation and no reflow［J］. Heart, 2003, 89(9):983-985.

［3］Piana RN, Paik GY, Moscucci M. Incidence and treatment of′no-re-flow′after percutaneous coronary intervention［J］. Circulation, 1994, 89(6):2514-2518.

［4］Watanabe T, Nanto S, Uematsu M, et al. Prediction of no-reflow phenomenon after successful percutaneous coronary intervention in patients with acute myocardial infarction: intravascular ultrasound findings［J］. Circ J, 2003, 67(8):667-671.

［5］Antoniucci D, Valenti R, Migliorini A, et al. Direct infarct artery stenting without predilation and no-reflow in patients with acute myocardial infarction［J］. Am Heart J, 2001, 142(4):684-690.

[6] Resnic FS, Wainstein M, Lee MK, et al. No-reflow is an independent predictor of death and myocardial infarction after percutaneous coronary intervention［J］. Am Heart J, 2003, 145(1):42-46.

[7]Gibson CM, Cannon CP, Murphy SA, et al. Relationship of the TIMI myocardial perfusion grades, flow grades, frame count, and percutaneous coronary intervention to long-term outcomes after thrombolytic administration in acute myocardial infarction［J］ . Circulation, 2002, 105(16):1909-1913.

[8] Hillegass WB, Dean NA, Liao L, et al. Treatment of no-reflow and impaired flow with the nitric oxide donor nitroprusside following percutaneous coronary interventions: initial human clinical experience［J］. J Am Coll Cardiol, 2001, 37(5):1335-1343.

[9]Klein LW, kern MJ, Berger P, et al. Society of cardiac angiography and interventions: suggested management of the no-reflow phenomenon on the cardiac catheterization laboratory［J］. Catheter Cardiovasc Interv, 2003, 60(2):194-201．

备注/Memo

备注/Memo:
收稿日期: 2009-05-10.通讯作者：汝磊生，副主任医师，主要从事冠心病介入治疗的 研究Email:rls9377@hotmail.com 作者简介：孙家安，主治医师，博士Email:sunjiaan@sohu.com
更新日期/Last Update: 2010-05-20