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目的评价冠状动脉内应用654-2对急性心肌梗死(AMI)经皮冠状动脉腔内成形术(PCI)后无复流现象的疗效及其安全性。方法21例AMI直接PCI后梗死相关动脉(IRA)存在无复流患者,男14例,女7例,年龄62.3±9.3岁。从症状开始至PCI术开通IRA时间7.14±2.32 h,术后平均TIMI血流1.76±0.43级,以硝酸甘油200μg冠状动脉内注入,10 min后以654-2 500μg冠状动脉内注入,于给药后第1、3、10分钟行冠状动脉造影(CAG)。应用TIMI血流计帧法和QCA分别测定硝酸甘油和654-2冠状动脉内给药后不同时间点的IRA血流速率帧数和管腔直径。结果①术后基础对照与硝酸甘油给药第1、3分钟时CAG血流帧数变化比较差异无显著性(83.80±9.40 vs 78.33±10.39帧、83.80±9.40 vs 77.47±10.51帧,P均>0.05);654-2给药后第1、3和10分钟时CAG血流帧数分别较给药前减少58.3%、56.2%和54.6%(P均<0.001);②冠状动脉内给予654-2后3 min时IRA管径亦较前略有增加(3.20±0.26 mm vs 3.30±0.25 mm,P>0.05);③654-2冠状动脉内给药后10 min内连续监测冠状动脉内压、外周血压、PR间期、QT间期和QRS时限各参数,与给药前比较差异均无显著性(P>0.05)。结论冠状动脉内应用654-2 500μg可改善AMI直接PCI术后无复流现象,且安全易行,可作为治疗IRA开通后无复流现象的有效药物之一。
Objective To evaluate the efficacy and safety of intracoronary 654-2 on no-reflow phenomenon after percutaneous transluminal coronary angioplasty (PCI) in patients with acute myocardial infarction (AMI). Methods There were 14 males and 7 females, aged 62.3 ± 9.3 years. There were 21 patients with no-reflow in the infarct-related artery (IRA) after PCI. From the onset of symptoms to PCI, the IRA time was 7.14 ± 2.32 h and the postoperative mean TIMI blood flow was 1.76 ± 0.43. The patients were injected with 200 μg nitroglycerin intracoronary injection and 654-2 500 μg intracoronary injection 10 min later. The first 1,3,10 minutes after coronary angiography (CAG). TIMI flowmeter frame method and QCA were used to determine the number of IRA blood flow frames and lumen diameter at different time points after administration of nitroglycerin and 654-2 coronary artery respectively. Results ① There was no significant difference in the number of CAG blood flow between the basal control group and the first and third minute of administration of nitroglycerin (83.80 ± 9.40 vs 78.33 ± 10.39, 83.80 ± 9.40 vs 77.47 ± 10.51, P> 0.05). The number of CAG blood flow frames decreased by 58.3%, 56.2% and 54.6% respectively at 1, 3, and 10 minutes after administration of 654-2 (all P <0.001). ② The intracoronary administration of 654- The diameter of IRA was also slightly increased at 3 min after 2 (3.20 ± 0.26 mm vs 3.30 ± 0.25 mm, P> 0.05). ③Coronary artery pressure was continuously monitored within 10 min after intracoronary administration of 654-2, , PR interval, QT interval and QRS duration were not significantly different from those before administration (P> 0.05). Conclusion Coronary application of 654-2 500μg can improve the no-reflow phenomenon after AMI direct PCI and is safe and easy to treat. It can be used as one of the effective drugs for treating no-reflow after IRA.