2021 年第 4 期 第 16 卷

冠状动脉内注射小剂量硫酸阿托品对纠正再灌注性缓慢性心律失常的效果

Application value of intracoronary injection of low-dose atropine sulfate on reperfusion bradyarrhythmia

作者：陈锦峰1周素芸2唐良秋1陈宝峰1陈云宪1

英文作者：Chen Jinfeng1 Zhou Suyun2 Tang Liangqiu1 Chen Baofeng1 Chen Yunxian1

单位：1粤北人民医院心内科，广东省韶关市512000；2粤北人民医院心电图室，广东省韶关市512000

英文单位：1Department of Cardiology Yue Bei People′s Hospital Guangdong Province Shaoguan 512000 China; 2Electrocardiogram Room Yue Bei People′s Hospital Guangdong Province Shaoguan 512000 China

关键词：急性下壁心肌梗死；经皮冠状动脉介入；再灌注缓慢性心律失常

英文关键词：Acuteinferiormyocardialinfarction;Percutaneouscoronaryintervention;Reimplantationbradyarrhythmia

• 摘要：

• 目的 探讨经导管冠状动脉内注射小剂量硫酸阿托品对急性下壁ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入（PCI）术中出现的再灌注性缓慢性心律失常的纠正效果。方法 选取2018年1月至2019年12月粤北人民医院收治的STEMI患者于PCI术中出现再灌注性缓慢性心律失常80例为研究对象，应用随机数字表法分为观察组和对照组，各40例。PCI术中闭塞血管开通后出现再灌注性缓慢性心律失常后，观察组经指引导管冠状动脉内缓慢注射小剂量硫酸阿托品，对照组经外周静脉注射常规剂量硫酸阿托品。比较2组术前基线资料、冠状动脉再灌注性缓慢性心律失常纠正指标以及术后1周和1、3个月主要不良心血管事件发生情况。结果 2组患者男性、高血压、糖尿病比例和年龄、体重指数、总胆固醇、低密度脂蛋白胆固醇、入院时胸痛时间、病变血管数量比较差异均无统计学意义(均P＞0.05）。与对照组比较，观察组再灌注性缓慢性心律失常在30 s内纠正成功率更高［100.0%(40/40)比60.0%（24/40）］，房室传导纠正时间、从导丝通过闭塞病变到冠状动脉血流恢复心肌梗死溶栓试验3级所需要的时间和PCI手术时间更短［(7.6±1.2)s比（38.0±15.3）s，(10.2±2.1)s比（45.4±5.9）s，(8.4±2.3)min比（16.5±5.2）min］，术后校正的心肌梗死溶栓试验帧数更低［(29±11)帧/s比（38±13）帧/s］，差异均有统计学意义（均P＜0.05）。2组术后30 min心绞痛缓解比例和术后90 min心电图ST段回落比例以及术后1周和术后1、3个月主要不良心血管事件发生率比较差异均无统计学意义（均P＞0.05）。结论 经导管小剂量硫酸阿托品，对纠正STEMI患者PCI术中出现的再灌注性缓慢性心律失常效果良好，并有助于改善患者预后。

• Objective To explore the value of transcatheter intracoronary injection of low-dose atropine sulfate on reperfusion bradyarrhythmia in patients with acute inferior ST-elevation myocardial infarction (STEMI) during percutaneous coronary intervention (PCI) . Methods From January 2018 to December 2019, 80 STEMI patients with reperfusion bradyarrhythmia during PCI admitted to Yue Bei People′s Hospital were selected. The patients were randomly divided into observation group and control group with 40 cases in each group. After onset of reperfusion bradyarrhythmia that followed occlusive vessel opened in PCI, the observation group was given intracoronary injection of low-dose atropine sulfate slowly by transcatheter guidance, and the control group was injected with conventional-dose atropine sulfate via peripheral vein. The baseline data before operation, corrective indicators of coronary reperfusion bradyarrhythmia, and occurrence of major adverse cardiovascular events at 1 week and 1, 3 months after operation were compared between the two groups. Results There were no significant differences in ratios of male, hypertension and diabetes, and age, body mass index, total cholesterol, low-density lipoprotein cholesterol, chest pain duration on admission and number of lesion vessel between the two groups (all P>0.05). Compared with the control group, the success rate of correcting  reperfusion bradyarrhythmia within 30 s in the observation group was higher ［100.0%(40/40) vs 60.0%(24/40)］, the time of atrioventricular conduction correction, the time of restore myocardial infarction thrombolytic test grade 3 from guidewire through occlusive lesion to coronary flow and the time of PCI were shorter ［(7.6±1.2)s vs (38.0±15.3)s, (10.2±2.1)s vs (45.4±5.9)s, (8.4±2.3)min vs (16.5±5.2)min］, and postoperatively corrected thrombolysis in myocardial infarction frame count was lower ［(29±114)frames/s vs (38±13)frames/s］(all P<0.05). There were no significant differences between the two groups in the rate of angina pectoris remission at 30 min after operation, rate of ST-segment reduction in electrocardiogram at 90 min after operation and incidences of major adverse cardiovascular events at 1 week and 1, 3 months after operation (allP>0.05). Conclusions  In the treatment of reperfusion bradyarrhythmia in STEMI patients, transcatheter intracoronary injection of low-dose atropine sulfate has more positive therapeutic significance in correcting reperfusion bradyarrhythmia, saving lives and improving prognosis of patients.