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目的探讨冠状动脉内应用山莨菪碱对急性心肌梗死介入治疗(AMI-PCI)后无再流患者的逆转作用并评价其对患者局部、整体心室功能和收缩同步性的影响。方法自2003年1月至2006年2月首发急性前壁心肌梗死并于12 h 内行急诊 PCI 的患者136例,根据心肌灌注分级方法(myocardial blush grade,MBG)确认无再流患者(MBG 0～1级)47例(男36例,女11例),平均年龄(63.23±11.24)岁,随机分为两组:A 组(山莨菪碱组,24例)和 B 组(对照组23例),A 组于 PCI 后即刻由指引导管冠状动脉内注射山莨菪碱1000μg/次,余治疗同 B 组。于 PCI 后即行左心室造影,测定心室容积、压力参数和室壁运动积分(wall motion score,WMS);AMI 后1周时行平衡法核素心室造影,测定左室整体和局部收缩功能、舒张功能和收缩同步性参数;AMI 后6个月随访时重复行心室造影和核素心室造影检查测定上述参数,同时随访并记录术后6个月内主要不良心脏事件(MACE)的发生率。结果 (1)A 组患者在冠状动脉内应用山莨菪碱1000μg/次,平均(2.53±0.34)次后 MBG由(0.74±0.32)级增加到用药后的(2.33±0.28)级。(2)AMI-PCI 后6个月随访时,A 组左室收缩末容积指数、左心室舒张末期容积指数、WMS 和左室舒张末期压均较 B 组明显降低[(40.53±8.12)ml/m~2比(50.32±8.26)ml/m~2,(80.13±9.74)ml/m~2比(87.17±10.25)ml/m~2,(8.24±1.31)比(10.23±1.82),(13.36±4.21)mm Hg(1 mm Hg=0.133 kPa)比(16.38±3.21)mm Hg,P 均<0.05];核素心室造影参数比较,A 组左室射血分数、峰射血率和峰充盈率等参数均较 B 组明显增加[(44.02±5.86)%比(38.52±5.18)%,(1.86±0.09)EDV/s 比(1.61±0.09)EDV/s,(2.19±0.32)EDV/s 比(1.78±0.17)EDV/s,P 均<0.05]。(3)A 组 AMI-PCI 后6个月左室局部射血分数(LrEF)_2-LrEF_8均分别较 B 组增加13.96%、25.02%、30.36%、22.86%、27.67%、22.07%和18.71%(P 均<0.05)。(4)相位分析示 A 组左室收缩同步性参数相角程、半高宽和峰相位标准差亦均低于 B 组[(46.04±8.93)°比(53.19±16.62)°,P<0.05;(23.02±6.27)°比(25.02±5.31)°,P>0.05;(7.92±4.12)°比(11.76±4.11)°,P<0.05]。(5)在6个月随访期内,A 组 MACE 发生率明显低于 B 组。结论冠状动脉内注射山莨菪碱可明显逆转 AMI-PCI 后无再流现象,改善无再流患者的心室功能和收缩同步性,降低 MACE 发生率。
Objective To investigate the reversal effect of anisodamine in patients undergoing coronary intervention without recurrence after acute myocardial infarction intervention (AMI-PCI) and evaluate its effect on the local, global ventricular function and systolic synchrony. Methods Thirty-six patients with acute anterior myocardial infarction (AMI) who underwent emergency PCI within 12 hours from January 2003 to February 2006 were enrolled in this study. MBR was assessed according to myocardial blush grade (MBG) Grade A), 47 cases (36 males and 11 females) with an average age of (63.23 ± 11.24) years were randomly divided into two groups: group A (anisodamine group, 24 cases) and group B (control group, 23 cases) In group A, anisodamine was injected into coronary artery of guide catheter immediately after PCI, and the rest was treated with B group. Left ventricular angiography was performed immediately after PCI, and ventricular volume, pressure parameters and wall motion score (WMS) were measured. One week after AMI, the left ventricular total and regional systolic function, diastolic function and systolic function Synchronization parameters were measured at 6 months after AMI. The above parameters were determined by repeat line ventriculography and radionuclide ventriculography at 6 months follow-up. The incidences of major adverse cardiac events (MACE) within 6 months after operation were recorded. Results (1) The application of anisodamine in the coronary artery in group A was increased by 1000μg / second and the mean (2.53 ± 0.34) times was increased from (0.74 ± 0.32) to 2.33 ± 0.28 after administration. (2) The left ventricular end-systolic volume index, left ventricular end-diastolic volume index, WMS and left ventricular end-diastolic pressure in group A were significantly lower than those in group B [(40.53 ± 8.12) ml / m ~ 2 (50.32 ± 8.26) ml / m ~ 2, (80.13 ± 9.74) ml / m ~ 2 vs 87.17 ± 10.25 ml / m ~ 2, 8.24 ± 1.31 vs 10.23 ± 1.82, (13.36 ± 4.21) mm Hg (1 mm Hg = 0.133 kPa), (16.38 ± 3.21) mm Hg, P all <0.05]. Compared with the parameters of radionuclide ventriculography, the ejection fraction, (4.82 ± 5.86)% (38.52 ± 5.18)%, (1.86 ± 0.09) EDV / s ratio (1.61 ± 0.09) EDV / s and (2.19 ± 0.32) EDV / s ratio (1.78 ± 0.17) EDV / s, P <0.05]. (3) The left ventricular ejection fraction (LrEF) _2-LrEF_8 in group A at 6 months after AMI-PCI increased by 13.96%, 25.02%, 30.36%, 22.86%, 27.67%, 22.07% and 18.71% (P <0.05). (4) The phase analysis showed that the phase angle, the full width at half maximum and the standard deviation of peak phase of group A were lower than that of group B [(46.04 ± 8.93) ° vs (53.19 ± 16.62) °, P <0.05 ; (23.02 ± 6.27) ° vs (25.02 ± 5.31) °, P> 0.05; (7.92 ± 4.12) ° vs (11.76 ± 4.11) °, P <0.05]. (5) The incidence of MACE in group A was significantly lower than that in group B within 6 months of follow-up. Conclusion Intracoronary injection of anisodamine can significantly reverse the no-reflow phenomenon after AMI-PCI and improve the ventricular function and systolic synchrony and reduce the incidence of MACE in patients without reperfusion.