中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2012年
1期
26-29
,共4页
冠状血管痉挛%乙酰胆碱%心电描记术%校正QT间期
冠狀血管痙攣%乙酰膽堿%心電描記術%校正QT間期
관상혈관경련%을선담감%심전묘기술%교정QT간기
Coronary vasospasm%Acetylcholine%Electrocardiography%Correct QT
目的 观察乙酰胆碱诱发冠状动脉痉挛试验前后心律失常及校正QT间期(QTc)的变化.方法 选择冠状动脉造影显示冠状动脉主干及其分支狭窄＜50％的受试者149例,行乙酰胆碱诱发冠状动脉痉挛试验,根据试验结果分为冠状动脉痉挛组80例、冠状动脉微循环障碍组31例和对照组38例,试验过程中经冠状静脉窦采血检测乳酸水平,全程监测并分析各组心律失常及心电图QTc的变化.结果 新出现的较严重心律失常发生率为28.2％(42/149),其中起搏心律发生率为18.1％(27/149),第二度或第三度房室阻滞发生率为6.0％(9/149),非持续性房性心动过速、心房颤动发生率为3.4％(5/149).三组各种心律失常的发生率比较差异无统计学意义(P＞0.05)；室性心动过速、心室颤动需电复律1例,发生率为0.7％(1/149),与冠状动脉痉挛相关.三组基础QTc比较差异无统计学意义(P＞0.05),注射乙酰胆碱后,冠状动脉痉挛组、冠状动脉微循环障碍组QTc分别延长至(448.4±37.6) ms及(455.9±36.5) ms,与对照组的(432.6±34.1) ms比较差异有统计学意义(P＜0.05).结论 乙酰胆碱诱发冠状动脉痉挛试验过程中,可引起缓慢性或快速性心律失常,大多与乙酰胆碱的药理作用相关,乙酰胆碱尚可引起QTc延长,冠状动脉痉挛、冠状动脉微循环障碍者QTc延长更显著.
目的 觀察乙酰膽堿誘髮冠狀動脈痙攣試驗前後心律失常及校正QT間期(QTc)的變化.方法 選擇冠狀動脈造影顯示冠狀動脈主榦及其分支狹窄＜50％的受試者149例,行乙酰膽堿誘髮冠狀動脈痙攣試驗,根據試驗結果分為冠狀動脈痙攣組80例、冠狀動脈微循環障礙組31例和對照組38例,試驗過程中經冠狀靜脈竇採血檢測乳痠水平,全程鑑測併分析各組心律失常及心電圖QTc的變化.結果 新齣現的較嚴重心律失常髮生率為28.2％(42/149),其中起搏心律髮生率為18.1％(27/149),第二度或第三度房室阻滯髮生率為6.0％(9/149),非持續性房性心動過速、心房顫動髮生率為3.4％(5/149).三組各種心律失常的髮生率比較差異無統計學意義(P＞0.05)；室性心動過速、心室顫動需電複律1例,髮生率為0.7％(1/149),與冠狀動脈痙攣相關.三組基礎QTc比較差異無統計學意義(P＞0.05),註射乙酰膽堿後,冠狀動脈痙攣組、冠狀動脈微循環障礙組QTc分彆延長至(448.4±37.6) ms及(455.9±36.5) ms,與對照組的(432.6±34.1) ms比較差異有統計學意義(P＜0.05).結論 乙酰膽堿誘髮冠狀動脈痙攣試驗過程中,可引起緩慢性或快速性心律失常,大多與乙酰膽堿的藥理作用相關,乙酰膽堿尚可引起QTc延長,冠狀動脈痙攣、冠狀動脈微循環障礙者QTc延長更顯著.
목적 관찰을선담감유발관상동맥경련시험전후심률실상급교정QT간기(QTc)적변화.방법 선택관상동맥조영현시관상동맥주간급기분지협착＜50％적수시자149례,행을선담감유발관상동맥경련시험,근거시험결과분위관상동맥경련조80례、관상동맥미순배장애조31례화대조조38례,시험과정중경관상정맥두채혈검측유산수평,전정감측병분석각조심률실상급심전도QTc적변화.결과 신출현적교엄중심률실상발생솔위28.2％(42/149),기중기박심률발생솔위18.1％(27/149),제이도혹제삼도방실조체발생솔위6.0％(9/149),비지속성방성심동과속、심방전동발생솔위3.4％(5/149).삼조각충심률실상적발생솔비교차이무통계학의의(P＞0.05)；실성심동과속、심실전동수전복률1례,발생솔위0.7％(1/149),여관상동맥경련상관.삼조기출QTc비교차이무통계학의의(P＞0.05),주사을선담감후,관상동맥경련조、관상동맥미순배장애조QTc분별연장지(448.4±37.6) ms급(455.9±36.5) ms,여대조조적(432.6±34.1) ms비교차이유통계학의의(P＜0.05).결론 을선담감유발관상동맥경련시험과정중,가인기완만성혹쾌속성심률실상,대다여을선담감적약리작용상관,을선담감상가인기QTc연장,관상동맥경련、관상동맥미순배장애자QTc연장경현저.
Objective To determine the changes of arrhythmia and correct QT (QTc) before and after the intracoronary injection of acetylcholine.Methods The intracoronary injection of acetylcholine was tesed in 149 patients with main coronary artery and branch stenosis less than 50％ by coronary arteriongraphy,149 patients were divided into coronary spasm group( 80 patients),microvascular spasm group (31 patients)and control group (38 patients) according to the results of the intracoronary injection of acetylcholine.The level of lactic acid in coronary sinus was detected,arrhythmia and QTc were monitored and analyzed.Results The emerging incidence of serious arrhythmia was 28.2％ (42/149).The incidence of cardiac rhythm by pacing was 18.1％ ( 27/149 ),the incidence of second to third degree atrioventricular block was 6.0％ (9/149 ),the incidence of paroxysmal atrial tachycardia and paroxysmal atrial fibrillation was 3.4％ (5/149).There was no significant difference in the incidence of arrhythmia among three groups (P ＞ 0.05).The incidence of ventricular tachycardia and ventricular fibrillation which needed to be managed by electroverting was 0.7％(1/149).And the ventricular tachycardia and ventricular fibrillation was found in coronary spasm group.The baseline QTc tended to have no significant change among coronary spasm group,microvascular spasm group and control group (P ＞ 0.05 ).After administration of acetylcholine in coronary spasm group and microvascular spasm group,QTc increased to (448.4 ±37.6) ms and (455.9 ±36.5) ms,and there was significant difference compared with that in control group[ (432.6 ± 34.1 ) ms ] (P ＜ 0.05).Conclusions Bradyarrhythmia and tachyarrhythmia is associated with the pharmacologic action of acetylcholine.However,ventricular tachycardia and ventricular fibrillation is associated with coronary artery spasm.The intracoronary injection of acetylcholine can cause the QTc increase,especially in patients with coronary spasm or microvascular spasm.
