三磷酸腺苷对房室旁路和房室结传导的影响

目的评价三磷酸腺苷（ＡＴＰ）对房室结及房室旁路传导特性的影响及剂量相关性，寻求最佳给药剂量。方法１０２例患者在窦性心律或心室起搏下股静脉快速推注ＡＴＰ０．１ｍｇ／ｋｇ（Ａ组）、０．２ｍｇ／ｋｇ（Ｂ组）、０．３ｍｇ／ｋｇ（Ｃ组）或生理盐水（Ｄ组），观察其电生理效应和副反应。结果对房室旁路前向和逆向传导的影响在各组间差异无显著性（Ｐ＞０．０５）。对房室结前向和逆向传导的阻断作用，Ａ、Ｂ、Ｃ组与Ｄ组相比差异有显著性（Ｐ＜０．０１）。Ａ、Ｂ、Ｃ各组间相比，仅Ａ、Ｃ组差异有显著性（Ｐ＜０．０５）。副反应发生率与剂量呈正相关。推导ＡＴＰ剂量与药效、副作用关系的一元三次多项式回归方程，确定阻断房室结逆传ＡＴＰ最佳剂量为０．２５ｍｇ／ｋｇ。结论ＡＴＰ应用宜个体化、标准化，推荐从０．１ｍｇ／ｋｇ起逐渐加量，射频消融术后如０．２５ｍｇ／ｋｇ仍不能阻断室房逆传，应考虑房室旁路未断或另有其它房室旁路存在。

Effects of adenosine triphosphate on antegrade and retrograde conduction of accessory pathway and atrioventricular node

bjectives The effects of adenosine triphosphate(ATP)on antegrade and retrograde conduction of accessory pathway(AP)and atrioventricular node(AVN)were evaluated and the optimal dosage was determined. Methods ATP was given to 102 patients who have accessory pathway with doses of 01 mg/kg(group A),02 mg/kg(group B),03 mg/kg(group C),and 09% saline(group D,as control)through right femoral vein during sinus rhythm or right ventricular pacing and the electrophysiologic effects as well as the side effects were observed. Results There was no significant difference about the effects of ATP on antegrade and retrograde conduction of AP among four groups (P>005),but there was significant difference about the various doses of ATP on blocking the antegrade and retrograde conduction of the AVN.In the latter circumstance,not only there was significant diference between group A,B,C and D respectively (P<001),but also between group A and group C(P<005).It also revealed a positive corelation between the frequency of adverse effects and dosage.According to the regression equation,the calculated optimal dose of ATP blocking the conduction of AVN was 025 mg/kg.WT5HZConclusion The ATP dose should be standardized and individualized,and would recommend to start with 01 mg/kg and then increase gradually.If blocking of retrograde ventriculoatrial conduction can not be achieved with 025 mg/kg ATP after radiofrequency ablation procedure of AP,either the target AP is still active or the presence of another AP should be considered.