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山莨菪碱在右冠状动脉心肌梗死急诊经皮冠状动脉介入时对心脏的保护作用

Cardioprotection of anisodamine in patients with right coronary artery acute myocardial infarction during percutaneous coronary intervention

摘要:

目的 探讨右冠状动脉(RCA)急性闭塞急诊经皮冠状动脉介入(PCI)再灌注即刻给予山莨菪碱能否降低再灌注损伤所致的心律失常、低血压状态及无复流现象的情况.方法 80例患者经冠脉造影证实为RCA闭塞所致的ST段抬高心肌梗死(STEMI),所有患者均在临时起搏器保护下行急诊PCI.患者随机分为山莨菪碱组40例,在导丝通过病变后球囊扩张前给予山莨菪碱5 mg;对照组40例,给予生理盐水;比较两组患者在球囊扩张并植入支架后冠脉血流TIMI级别;血流恢复30 min内心率/律及血流动力学的变化;血流恢复后30 min及24 h的ST段回落情况;心肌坏死标记物峰值出现时间.结果 山莨菪碱组共发生窦性心动过缓50.0%,高度房室传导阻滞(AVB)17.5%,频发室性期前收缩50.0%,阵发性室性心动过速35.0%,室颤12.5%,低血压47.5%,慢血流现象7.5%,低于对照组窦性心动过缓77.5%,高度AVB 35.0%,频发室性期前收缩72.5%,阵发性室性心动过速42.5%,室颤20.0%,低血压75.0%,慢血流现象15.0%(均P<0.05).术后30min山莨菪碱组与对照组相比ST段回落>50%者增多(P<0.05);至术后24 h两组差异无统计学意义(P>0.05).山莨菪碱组与对照组比较,肌酸激酶同工酶和心肌肌钙蛋白峰值出现时间明显提前(P<0.05).术后30 min及术后24 h时山莨菪碱组血清中超氧化物歧化酶高于对照组;丙二醛低于对照组(均P< 0.05).结论 RCA相关急性心肌梗死急诊PCI再灌注前应用山莨菪碱可明显降低再灌注心律失常、低血压状态、慢血流的发生率,其作用机制可能与山莨菪碱抑制氧自由基和改善微循环密切相关.

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abstracts:

Objective To investigate the protective efficacy of anisodamine against heart injury after ischemia reperfusion in patients with right coronary artery acute myocardial infarction during percutaneous coronary intervention,and to explore the possible mechanism. Methods Totally 80cases with ST elevation myocardial infarction (STEAMI) were received primary percutaneous coronary intervention (PCI).All patients were randomly divided into 2 groups:anisodamine group (40 cases),5 mg anisodamine was administered when the blood flow recovery after the balloon extension,and control group (40 cases) received saline. The rhythm and rate of heart were observed through the electrocardiogram (ECG) monitor in 30 min after the blood flow recovery.The pressure of aorta were observed through the pressure sensor connected to aorta through catheter.TIMI flow grade (TFG)and corrected TIMI frame count (cTFC) were used to evaluate coronary flow during PCI.Electrocardiography was performed to analysis ST segment resolution 30 min and 24 h after PCI.Venous blood was obtained before and 30 min,1 h,2 h,4 h,24 h and 48 h after PCI to test the levels of superoxide dismutase (SOD),malonyldialdehyde (MDA),creatine kinase isozymes (CKMB) and cardiac troponin I(cTNI) in plasma. Results There were 20 cases(50.0%)of sinus bradycardia,7cases(17.5 %) of high degree atrioventricular block (AVB),20 cases (50.0 % )of frequent ventricular premature,14 cases (35.0%) of paroxysmal supraventricular tachycardia, 5 cases (12.5%) of ventricular fibrillation,19 cases(47.5 %) of hypotension,3 cases (7.5 %)of no-reflow phenomenon in anisodamine group which were lower than control group,31 cases (77.5%)of sinus bradycardia,14 cases(35.0%) of high degree AVB,17 cases(72.5%) of paroxysmal supraventricular tachycardia,8 cases (42.5%) of ventricular fibrillation,30 cases (75.0%) of hypotension,6 cases of no-reflow phenomenon (P<0.05).There were more ST fall>50% after rise in anisodamine group than control group after PCI 30 min,but no difference was found after 24 h. The CKMB and cTNI peak value occurred earlier in anisodamine group than control group (P<0.05).The level of SOD was increased,MDA decreased in anisodamine group compared with control group after PCI 30 min and 24 h (both P<0.05). Conclusions The use of anisodamine as the blood flow recovery after the balloon extension can reduce no-reflow phenomenon,various of arrhythmia and hypotension during PCI.The underlying mechanism involves the inhibition of oxygen radicals and the improvement of microcirculation.

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