论文部分内容阅读
目的评价经皮冠状动脉介入治疗(PCI)中冠状动脉内(IC)应用腺苷的心肌保护作用。方法对2004年12月至2006年4月在河北医科大学第一医院和石家庄市第三医院住院且符合入选条件的111例冠心病患者随机分为生理盐水IC注射组55例(对照组)与腺苷IC注射组56例(腺苷组)。对照组予以生理盐水,腺苷组用腺苷300μg,持续IC注射1min,观察IC心电图(IC-ECG)ST段最大抬高程度、术后心脏肌钙蛋白I(cTnI)峰值及左心室射血分数(LVEF)。急性心肌梗死(AMI)患者按心肌梗死溶栓试验血流分级对梗死相关动脉进行再通后血流评价,并分析术后1h心电图ST段抬高总和回落百分比(sumSTR)。结果腺苷组患者术后cTnI峰值低于对照组(P<0.05)。AMI时sumSTR腺苷组下降幅度较对照组明显(P<0.05);PCI后4周无论腺苷组还是对照组LVEF均比3d时有明显改善(P<0.05),4周时腺苷组LVEF较对照组改善更显著(P<0.05)。择期PCI患者腺苷组与对照组IC-ECG的ST段抬高发生率及抬高的程度低于对照组。结论PCI时IC注射腺苷,可以减轻心肌微损伤,显著缓解AMI血管开通背景下发生的缺血-再灌注损伤,并有益于改善左心功能。
Objective To evaluate the protective effects of adenosine on intracoronary (IC) administration in percutaneous coronary intervention (PCI). Methods One hundred and eleven patients with coronary heart disease who were admitted to the First Hospital of Hebei Medical University and the Third Hospital of Shijiazhuang City from December 2004 to April 2006 were randomly divided into saline injection group (n = 55) and control group 56 cases of adenosine IC injection group (adenosine group). The control group was given normal saline. The adenosine group was treated with adenosine 300μg for 1min. The maximum elevation of ST-segment of IC-ECG, peak of cardiac troponin I (cTnI) and left ventricular ejection Score (LVEF). Acute myocardial infarction (AMI) in patients with myocardial infarction thrombolysis grading according to recanalization after infarction related artery blood flow evaluation, and analysis of 1h postoperative ECG ST-segment elevation sum total decline (sumSTR). Results The peak of cTnI in adenosine group was lower than that in control group (P <0.05). Compared with the control group, the decrease of sumSTR in adenosine group was significant at AMI (P <0.05); LVEF of both adenosine group and control group was significantly improved at 4 weeks after PCI (P <0.05); at 4 weeks, LVEF Compared with the control group, the improvement was more significant (P <0.05). The incidence and elevation of ST-segment elevation of IC-ECG in adenosine group and control group were lower than those in control group. Conclusions IC injection of adenosine at the time of PCI can reduce myocardial micro injury and significantly reduce the ischemia-reperfusion injury in the context of AMI opening and improve left ventricular function.