摘要
目的探讨不同剂量腺苷对急性sT段抬高心肌梗死（STEMI）患者经皮冠状动脉成形术（PCI）后左心室功能、梗死面积的影响。方法将发病在12h内的STEMI患者按1：1：1比例随机分为对照组（生理盐水1mL／min，n=31）、腺苷低剂量组（50μg·kg^-1·min^-1，n=32）和腺苷高剂量组（70μg·kg^-1·min，n-27）。生理盐水及腺苷经静脉持续滴注3h。记录术中无复流发生率。术后24h及6个月分别采用心脏超声多普勒及核素心肌灌注显像（99mTc-SPECT）测定左心室功能及梗死面积。结果90例STEMI患者中，对照组术后即刻无复流发生率（11例，35．5％）显著高于腺苷低剂量组（2例，6．3％，P=0．008）和腺苷高剂量组（1例，3．7％，P=0．034）。与对照组比较，术后24h腺苷低剂量组左心室射血分数相对提高5．8％（P=0．012），腺苷高剂量组相对提高10．9％（P=0．007），二种剂量之间比较差异无统计学意义（P=0．139）；6个月时腺苷低剂量组左心室射血分数相对提高9．5％（P=0．001），腺苷高剂量组相对提高10．0％（P=0．001），二种剂量之间比较差异无统计学意义（P=0．877）。6个月时腺苷高剂量组梗死面积相对缩小24．2％（P=0．008）。结论腺苷能够显著减少无复流发生率，改善左心室收缩功能。高剂量腺苷具有显著缩小梗死面积的作用。
Objective To discuss the effect of intravenous adenosine on left ventricular function and infarct size in the patients with ST - segment elevation myocardial infarction （ STEMI ） undergoing primary percutaneous coronary intervention （PCI）. Methods Patients with STEMI within 12 hours from the onset of symptoms were randomized by 1 ： 1 ： 1 ratio to receive either adenosine 50 p,g ~ kg^- 1 . min^-l（low-dose group, n=32） or 70 μg · kg^-l . min^-1（high-dose group, n=27）, or saline （control group, n = 31） immediately before PCI procedure. All the patients received 3 -hour infusions of drugs. Recurrence of no - reflow was found. Left ventricular function detected by Doppler echocardiography and infarct size by 99mTc single - photon emission computed tomography （SPECT） at 24 h and 6 - month were followed - up. Results The average time from the onset of symptom to PCI was 357rain. For all the patients, there were no significant differences among three groups. Drugeluting stents were deployed in all patients after pre - dilatation with conventional balloon. No - reflow immediately （ 11,35.5% ） after stenting procedure in control group was significantly higher than that in low - dose （ n = 2,6. 3% , P = O. 008 ） and high - dose （ n = 1,3.7% ） groups （ P = 0. 034 ）. Comparedwith control group, left ventricular ejection fraction at both 24 hour （ 46. 3 % vs 42. d% , P = 0. 012 ） and 6 month {48.7% vs 43.9%, P = 0. 001 ） in the patients received adenosine was improved significantly, without dose- dependent pattern. Compared with control group , infarct size at 6 month （28.0% vs 36. 3% ） in adenosine group was decreased significantly （ P =0. 016 ） with typical dose - dependent pattern. Infarct size in high - dose group was decreased by 24. 2%（ 27. 5% vs 36. 3% ,P = 0. 008 ）. Conclusion Intravenous adenosine administration was safe with significant decrease of the recurrence of no- reflow and improvement of left ventricular systolic function. High dose of adenosine
出处
《中国急救医学》
CAS
CSCD
北大核心
2009年第9期776-780,共5页
Chinese Journal of Critical Care Medicine
关键词
急性心肌梗死
腺苷
心肌再灌注损伤
左心室功能
梗死面积
Acute myocardial infarction
Adenosine
Myocardial reperfusion injury
Left ventricular function
Infarct size
