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首页> 外文期刊>Canadian Journal of Physiology and Pharmacology >Intracoronary boluses of adenosine and sodium nitroprusside in combination reverses slowo-reflow during angioplasty: a clinical scenario of ischemic preconditioning.
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Intracoronary boluses of adenosine and sodium nitroprusside in combination reverses slowo-reflow during angioplasty: a clinical scenario of ischemic preconditioning.

机译：冠状动脉内的腺苷和硝普钠合用可逆转血管成形术中缓慢/不复流：缺血预处理的临床情况。

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摘要

No or slow reflow following percutaneous coronary intervention (PCI), despite the presence of a patent epicardial vessel, is a serious complication resulting in increased morbidity and mortality. In the present study, we have evaluated the combination therapy of adenosine and sodium nitroprusside administered as sequential intracoronary (IC) boluses on no-reflow during PCI. Seventy-five high risk acute coronary syndrome patients who underwent PCI with evidence of initial less than TIMI (thrombolysis in myocardial infarction) III flow or developed deterioration in TIMI flow during the procedure were randomized to prophylactic administration of multiple boluses of IC saline solution, adenosine (12 microg/bolus) or the combination of adenosine (12 microg/bolus) and sodium nitroprusside (50 microg/bolus), sequentially. Assessment of TIMI and the TMP (tissue myocardial perfusion) grade was done and major adverse cardiac events (MACE) were assessed at the end of 6 months. Slow or no-reflow was persistent in 70% patients receiving saline solution, 31% patients receiving adenosine, and 4% patient receiving the combination. IC injection with saline solution did not produce improvement in TIMI flow or TMP grade. IC injection with combination resulted in greater improvement of TIMI flow and TMP grade. The crossover of patients with no-reflow in saline solution group or adenosine with combination treatment was associated with reestablishment of TIMI II in 4 and TIMI III in 20 patients. Our data suggest that combination therapy of adenosine and nitroprusside is safe and provides better improvement in coronary flow and MACE as compared with IC adenosine alone in cases of impaired flow during coronary interventions.
机译：尽管存在心外膜未闭血管，但经皮冠状动脉介入治疗（PCI）后无复流或缓慢复流是严重并发症，导致发病率和死亡率增加。在本研究中，我们评估了腺苷和硝普钠的联合治疗，作为PCI期间无复流的连续冠状动脉内（IC）推注。在该过程中接受PCI的证据表明，最初接受TIMI（心肌梗塞溶栓）少于III期血流或发生TIMI血流恶化的75例高危急性冠状动脉综合征患者被随机分配至多剂量IC盐溶液，腺苷预防性给药（12微克/次）或腺苷（12微克/次）和硝普钠（50微克/次）的组合。对TIMI和TMP（组织心肌灌注）等级进行了评估，并在6个月末评估了严重的不良心脏事件（MACE）。接受盐溶液的70％患者，接受腺苷的31％患者和接受联合用药的4％患者持续缓慢或不复流。用盐溶液进行IC注射不会改善TIMI流量或TMP等级。结合使用IC注入可显着改善TIMI流量和TMP等级。盐水溶液组或腺苷无复流患者的联合治疗与4例TIMI II和20例TIMI III的重建相关。我们的数据表明，与单独使用IC腺苷相比，在冠脉介入治疗期间血流受损的情况下，腺苷和硝普钠的联合治疗是安全的，并且可以改善冠脉血流和MACE。

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