硝普钠治疗急性心肌梗死患者介入术后无复流现象的临床研究

目的观察冠状动脉内注射硝普钠对急性心肌梗死(acute myocardial infarction,AMI)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术中无复流的疗效。方法将同期于我院行PCI且术中出现无复流的79例AMI患者随机分为实验组40例(硝普钠组)和对照组39例(硝酸甘油组),两组手术方法相同,出现无复流现象后分别经冠状动脉内注入硝普钠(每次用0.05~0.1mg)和硝酸甘油(每次用0.1~0.2mg),术中出现低血压给予阿拉明0.5~1mg。观察两组注射药物后首次和末次冠脉造影图像,分析其冠脉特征(TIMI血流分级、TIMI心肌灌注分级);观察两组冠脉内有创血压、心率变化及术后7d的射血分数;记录患者住院期间及随访80d内的主要心脏不良事件发生率(MACE)。结果两组患者的一般基线资料差异无统计学意义;冠脉内注射药物后:实验组TIMI分级达到3级以上的比例明显高于对照组(77.5%vs46.2%,P=0.004),TMP分级达到3级以上的比例高于对照组(75.0%vs48.7%,P=0.016);两组冠脉内有创血压及心率变化的差异无统计学意义(P>0.05);实验组术后7dLVEF高于对照组(54.6%±9.2%,43.8%±5.9%);实验组住院期间MACE发生率低于对照组(5.0%vs20.5%,P=0.038);实验组在平均80d随访期间发生总的MACE事件比对照组相对有所减少(7.5%vs25.6%,P=0.030)。结论冠状动脉内注射硝普钠,可以改善AMI患者PCI术中发生无复流后冠状动脉血流和心肌组织灌注分级,同时改善患者心功能及预后,是治疗此类患者的一种简单有效的方法。

Clinical research of nitroprusside in treating the acute myocardial infarction patients with no-reflow phenomenon after primary percutaneous coronary intervention

Objective To explore the effect of intracoronary nitroprusside in the acute myocardial infarction patients with no-reflow phenomenon after primary percutaneous coronary intervention. Methods A total of 79 individuals,who had no-reflow phenomenon after primary percutaneous coronary intervention,were randomly assigned to receive either intracoronary nitroprusside (test groups 40 individuals, 0.05~0.1mg per time) or intracoronary nitroglycerin (control group 39 individuals, 0.1~0.2mg per time),aramine (0.5~1mg per time) would be given if hypotension happened in the PCI. Clinical and angiographic features (coronary arteries blood flow TIMT grade and TIMI myocardial perfusion TMP) between two groups the first 5min and the last after intracoronary nitroprusside or nitroglycerin were analyzed. The change of invasive blood pressure of coronary and heart rates and the left ventricular ejection fraction in the 7 postoperative days were observed.The incidence of major adverse cardial events (MACE)in the hospital and in the follow-up period (80 days in average) was recorded. Results There were no significant difference in the baseline characteristic and the change of invasive blood pressure of coronary and heart rates between two groups. After intracoronary drugs,TIMI flow grade was observed more frequently in the test group compared with the control group(77.5% vs 46.2%,P=0.004).TMP grade 3 was observed more frequently in the test group compared with the control group (75.0% vs 48.7%,P=0.016).The higher LVEF in the 7 postopreative days was obsevered in the test group compared with the control group. The incidence of MACE in the hospital and in the follow-up period (80 days in average) in the test group was lower than the control group. Conclusion Intracoronary nitroprusside can significantly improve the flow restoration and myocardial perfusion in the acute myocardial infarction patients with no-reflow phenomenon after primary percutaneous coronary intervention,and also improve the patients’ cardiac function and the prognostic.It may be an effective and simple way targeting this patients.