2021 年第 8 期 第 16 卷

小剂量多巴胺在冠状动脉慢性完全闭塞病变介入治疗术中的有效性和安全性

Efficacy and safety of low-dose of dopamine in interventional therapy for coronary artery chronic total occlusion

作者：李文铮吴铮吴小凡李世英吕昀赵烨婧刘佟程子超刘严慈柳景华

英文作者：Li Wenzheng Wu Zheng Wu Xiaofan Li Shiying Lyu Yun Zhao Yejing Liu Tong Cheng Zichao Liu Yanci Liu Jinghua

单位：首都医科大学附属北京安贞医院冠心病中心北京市心肺血管疾病研究所100029

英文单位：Center for Coronary Artery Disease Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：冠状动脉；慢性完全闭塞病变；介入治疗；多巴胺；低血压研究所100029

英文关键词：Coronaryartery;Chronictotalocclusion;Interventionaltherapy;Dopamine;Hypotension

• 摘要：

• 目的 探讨慢性完全闭塞病变(CTO)经皮冠状动脉介入（PCI）治疗术中预防性使用小剂量多巴胺的有效性和安全性。方法 连续入选2019年1月至2020年1月于首都医科大学附属北京安贞医院心内科诊治的冠状动脉CTO介入治疗患者120例，患者介入治疗开始时收缩压均≤110 mmHg（1 mmHg=0.133 kPa）。入选患者按1︰1交替分为预防治疗组和对照组，各60例。预防治疗组在PCI开始时使用微量泵给予多巴胺2 μg/（kg·min）持续静脉泵入至手术结束并由术者根据经验调整剂量。对照组术中术者根据经验使用多巴胺。比较2组低血压、出血性卒中、穿刺部位血肿和平稳期恶心呕吐发生率。记录2组发生低血压患者的收缩压最低值、低血压持续时间、多巴胺最大剂量。结果 预防治疗组低血压发生率明显低于对照组［18.3%(11/60)比36.7%(22/60)］（P＜0.05）。2组穿刺部位血肿、平稳期恶心呕吐发生率差异均无统计学意义（均P＞0.05），且均未发生出血性卒中。预防治疗组低血压患者收缩压最低值、低血压持续时间、多巴胺最大剂量与对照组比较［（72±8）mmHg比（64±12）mmHg、5(5,10)min比5(5,11)min、10(10,10)μg/(kg·min)比10(10,16)μg/(kg·min)］差异均无统计学意义（均P＞0.05）。结论 CTO-PCI患者预防性使用小剂量多巴胺可减少术中低血压的发生，且安全性较好。

• Objective To explore the efficacy and safety of low-dose of dopamine prophylactic use during percutaneous coronary intervention (PCI) for chronic total occlusion(CTO). Methods From January 2019 to January 2020, 120 patients undergoing interventional therapy for CTO in Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University were continuously enrolled. Systolic blood pressure of patients at the beginning of interventional therapy was ≤110 mmHg. The patients were alternately divided into preventive treatment group and control group according to 1∶1, with 60 cases in each group. At the beginning of the PCI, the preventive treatment group was given 2 μg/（kg·min） dopamine micro-pump until the end of the operation, and the dose was adjusted by the operator according to experience. In the control group, dopamine was used according to surgeons′ experience. The incidences of hypotension, hemorrhagic stroke, hematoma at punctured sites and nausea and vomiting during stable period were compared between the two groups, and the lowest systolic blood pressure, duration of hypotensin and maximum dose of dopamine of patients with hypotension in the two groups were recorded. Results The incidence of hypotension in the preventive treatment group was significantly lower than that in the control group［18.3%(11/60) vs 36.7%(22/60)］(P＜0.05). There were no significant differences in incidences of hematoma at punctured sites and nausea and vomiting during stable period between the two groups (both P＞0.05), and no hemorrhagic stroke was occurred in both groups. There were no significant differences in the lowest systolic blood pressure, duration of hypotension and maximum dose of dopamine between the preventive treatment group and the control group ［（72±8）mmHg vs （64±12）mmHg, 5(5,10)min vs 5(5,11)min, 10(10,10)μg/(kg·min) vs 10(10,16)μg/(kg·min)］ (all P＞0.05). Conclusion Low-dose of dopamine prophylactic use can reduce the occurrence of intraoperative hypotension, and the safety is good.