艾司洛尔对心肌桥患者壁冠状动脉血流动力学的作用

目的　探讨β受体阻滞剂艾司洛尔对心肌桥患者的壁冠状动脉受压迫程度和血流速率的影响。方法　8例心肌桥患者在静脉滴注艾司洛尔前后观察壁冠状动脉受压程度的变化,并运用腔内多普勒技术观察壁冠状动脉的基础峰值血流速率 (bAPV)、最大峰值血流速率 (hAPV)、冠状动脉血流储备(CFR)的变化。结果　艾司洛尔使壁冠状动脉受压程度由用药前 ( 58 0±14 7 )%降低至(26 0±9 8)% (P<0 01);艾司洛尔使近段和远段bAPV分别由 ( 19 4±4 9 )cm/s和 ( 18 4±3 6)cm/s下降至(14 7±3 9)cm/s和(15 1±1 5)cm/s,用药前后相比差异均有统计学意义 (P分别为<0 01和<0 05);在充血状态下壁冠状动脉近段和远段的hAPV分别由 ( 54 1±14 9 )cm/s和(44 7±9 4)cm/s变为(49 7±16 4)cm/s和(48 9±10 1)cm/s; 远段和近段的CFR由 (2 8±0 3)和(2 5±0 5)分别上升为(3 4±0 5)和(3 2±0 6) (P均 <0 01)。结论　艾司洛尔可使壁冠状动脉受压程度减轻,CFR增加至正常水平。

The effect of esmolol on hemodynamic of the myocardial bridging-mural mural coronary artery

OBJECTIVE: To assess the effect of beta blocker on blood flow velocity and reserve on the intramural coronary artery of patients with myocardial bridging. METHODS: In 8 patients with myocardial bridge, intracoronary Doppler was performed before and after esmolol was given intravenously. The basic average peak velocity (bAPV), hyperaemic average peak velocity (hAPV) of blood flow, and coronary flow reserve (CFR) proximal and distal to the mural myocardial bridging was measured and compared. RESULTS: After esmolol injection, the mural coronary diameter systolic reduction decreased from (58.0 +/- 14.7)% to (26.0 +/- 9.8)% (P < 0.01); the bAPV proximal and distal to myocardial bridging separately decreased from (19.4 +/- 4.9) cm/s and (18.4 +/- 3.6) cm/s to (4.7 +/- 3.9) cm/s (P < 0.01) and (15.1 +/- 1.5) cm/s (P < 0.05). Under hyperemization, esmolol changed the hAPV of proximal and distal to myocardial bridging separately from (54.1 +/- 14.9) cm/s and (44.7 +/- 9.4) cm/s to (49.7 +/- 16.4) cm/s and (48.9 +/- 10.1) cm/s (all P > 0.05); thus, the value of CFR both proximal and distal to myocardial bridge increased separately from 2.8 +/- 0.3 and 2.5 +/- 0.5 to 3.4 +/- 0.5 and 3.2 +/- 0.6 (all P < 0.01). CONCLUSION: Esmolol can decreased the compression of the intramural coronary artery and increased the CFR to normal level of it.