高剂量腺苷在急性ST段抬高心肌梗死直接经皮冠状动脉介入治疗中的应用效果评价

目的:评价高剂量腺苷在急性ST段抬高心肌梗死直接经皮冠状动脉介入治疗中的应用效果。方法:ST段抬高心肌梗死患者84例,随机分为研究组和对照组各42例。所有患者均直接进行经皮冠状动脉介入治疗,研究组即刻给予腺苷600 μg+0.9%氯化钠注射液10 mL,对照组即刻给予腺苷300 μg+0.9%氯化钠注射液10 mL,均持续冠状动脉内注射1 min再给予支架,术毕进行再通后血流评价,并比较肌酸激酶、肌酸激酶同工酶、肌钙蛋白I等生化指标和术后心电图ST段抬高回落率及左心室射血分数变化。结果:研究组患者治疗后生化指标和心电图指标均显著优于对照组(P<0.05~P<0.01)。2组患者术前和术后30 min TIMI血流分级差异无统计学意义(P>0.05),研究组术后即刻TIMI血流分级优于对照组(P<0.05)。研究组患者术后不良反应和术后30 d恶性心血管事件发生率与对照组差异均无统计学意义(P>0.05)。结论:高剂量腺苷在急性ST段抬高心肌梗死直接PCI治疗中安全有效,具有临床应用价值。

Clinical efficacy evaluation of the high dose adenosine through percutaneous coronary intervention in the treatment of the acute ST segment elevation myocardial infarction

Objective:To evaluate the clinical efficacy of high dose adenosine through percutaneous coronary intervention in the treatment of the acute ST segment elevation myocardial infarction. Methods:Eighty-two patients with acute ST segment elevation myocardial infarction were randomly divided into the study group and control group(42 cases each group). All patients were treated with percutaneous coronary intervention( PCI) . The study group and control group were treated with 600μg of adenosine combined with 10 mL of saline and 300 μg of adenosine combined with 10 mL of saline for 1 min,respectively,then two groups were additionally treated with stenting. Coronary flow of infarction related artery ( IRA ) was assessed after treatment. The serum levels of creatine kinase, isoenzyme of creatine kinase and cardiac troponin I,drop rate of ST segment elevation and left ventricular ejection fraction between two groups were compared after operation. Results:The biochemical and ECG indexes in study group were significantly better than those in control group after treatment(P<0. 05 to P<0. 01). The difference of TIMI rating between two groups before operation and after 30 min of operation was not statistically significant(P>0. 05). The TIMI rating in study group at the end of operation was better than that in control group(P<0. 05). The differences of the incidence of postoperative adverse reactions and serious cardiovascular events after 30 days of operation between two groups were not statistically significant(P >0. 05). Conclusions:The treatment of the acute ST segment elevation myocardial infarction with the high dose of adenosine through percutaneous coronary intervention is safe and effective, which has certain application value.