冠状动脉内注射美托洛尔对介入性心肌损伤的保护作用

目的研究冠状动脉内注射美托洛尔对介入性心肌损伤的保护作用。方法将86例行冠状动脉介入治疗（PCI）的患者随机分为试验组和对照组。两组在PCI前向冠状动脉内分别注射美托洛尔2rag（1mg／ml）和同等容积的生理盐水安慰剂。测定术前1h、术后6h、术后24h的血清肌钙蛋白I（cTNI）、肌酸激酶同工酶MB（CKMB）的变化，记录患者的胸痛症状以及心率、血压变化和球囊（或支架）的扩张压力、扩张次数。结果对照组与试验组之间cTNI、CKMB比较差异有统计学意义（P=0．004，0．003）；两组的心率、血压和扩张压力、扩张次数比较差异均无统计学意义（P〉0．05）。冠状动脉内注射2mg美托洛尔未见明显的不良反应。结论冠状动脉内注射小剂量美托洛尔是安全有效的。在介入治疗时能在一定程度上有效地保护心肌细胞，减少心肌细胞的损伤；其对心率、血压影响不明显。

The Protective Effectiveness of Intracoronary Metoprolol for Intervention-Related Myocardial Injury

Objective To explore the cardial protective efficacy and safety of intracoronary metoprolol in patients undergoing percutaneous coronary intervention（PCI）. Methods Patients （ n = 86） were randomly assigned to receive intracoronary metoprolol （ n = 46） or placebo （ n = 40）. Both of them were delivered via an intracoronary catheter to the coronary lesion before PCI. cTNI and CKMB were detected at 1 h before PCI and 6 h, 24 h after PCI. Record the chest pain, heart rate, blood pressure, dilation times and pressure. Results There was a significant difference between two groups in cTNI （ P = 0. 004） and CKMB （ P = 0. 003 ）. The heart rate and blood pressure weren＇ t affected obviously. No side effects were observed during PCI process. Conclusions Intracoronary metoprolol may reduce the injury of myocardial cell during PCI by enhancing the anti-myocardial ischemic effect. It doesn＇ t affect the heart rate and blood pressure obviously.