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目的应用心肌声学造影(MCE)评价急性前壁心肌梗死(AMI)患者急诊PCI围术期静脉应用腺苷对PCI术后心肌灌注的改善作用。方法连续入选解放军总医院2008年11月至2010年1月行急诊PCI术的急性前壁心肌梗死患者40例,分为对照组(17例)与腺苷组(23例)。腺苷组于PCI术前10min静脉给予腺苷(50μg·min-1·kg-1),持续3h。术后即刻观察心肌梗死溶栓实验(TIMI)血流,术后7d行心肌声学造影检查观察心肌灌注情况,普通超声心动图检查测定左室收缩功能,随访患者1个月,观察主要心血管事件发生情况。结果两组术后TIMI0～2级血流发生率差异无统计学意义(17.6%比11%,χ2=0.00,P>0.05)。腺苷组心肌灌注速度(β)较对照组增加(0.12±0.04比0.09±0.03,t=5.00,P<0.05),心肌灌注血流量(A·β)也高于对照组(0.75±0.40比0.52±0.26,t=3.61,P<0.05)。腺苷组有更多节段心肌恢复较高水平灌注(42.5%比17.3%,χ2=47.204,P<0.05)。腺苷组左室射血分数高于对照组[(50.87±5.57)%比(46.12±6.29)%,t=2.52,P<0.05)]。结论急诊PCI围术期静脉应用腺苷可有效改善急性前壁心肌梗死患者的心肌灌注,使更多心肌恢复高水平组织灌注,改善心功能,而心肌声学造影可准确、安全、有效地对PCI后心肌组织灌注的情况进行评价。
Objective To evaluate the effect of intravenous administration of adenosine on myocardial perfusion after percutaneous coronary intervention in patients with acute anterior myocardial infarction (AMI) by myocardial contrast echocardiography (MCE). Methods Forty patients with acute anterior myocardial infarction undergoing emergency PCI from November 2008 to January 2010 were randomly divided into control group (17 cases) and adenosine group (23 cases). Adenosine group (50μg · min-1 · kg-1) was given intravenously 10 min before PCI for 3h. Myocardial infarction thrombolysis (TIMI) blood flow was observed immediately after operation. Myocardial perfusion was measured by myocardial contrast echocardiography at 7 days after operation. Left ventricular systolic function was measured by echocardiography. Patients were followed up for 1 month to observe the major cardiovascular events What happened? Results There was no significant difference in the incidence of grade 0 ~ 2 TIMI flow between the two groups (17.6% vs 11%, χ2 = 0.00, P> 0.05). The myocardial perfusion rate (β) in adenosine group was significantly higher than that in control group (0.12 ± 0.04 vs. 0.09 ± 0.03, t = 5.00, P <0.05), and myocardial perfusion (A · β) 0.52 ± 0.26, t = 3.61, P <0.05). Adenosine group had more segmental myocardial recovery at higher levels of perfusion (42.5% vs 17.3%, χ2 = 47.204, P <0.05). The left ventricular ejection fraction in adenosine group was higher than that in control group [(50.87 ± 5.57)% vs (46.12 ± 6.29)%, t = 2.52, P <0.05). Conclusions Intravenous administration of adenosine during emergency perioperative PCI can effectively improve myocardial perfusion in patients with acute anterior myocardial infarction, restore more myocardium to high levels of tissue perfusion and improve cardiac function, while myocardial contrast echocardiography can accurately, safely and effectively control PCI After myocardial tissue perfusion were evaluated.