[1]金 鹏,周炳凤.去甲肾上腺素在心肌梗死合并低血压中的应用[J].医学信息,2020,33(07):57-60.[doi:10.3969/j.issn.1006-1959.2020.07.017]
　JIN Peng,ZHOU Bing-feng.Application of Norepinephrine in Myocardial Infarction with Hypotension[J].Medical Information,2020,33(07):57-60.[doi:10.3969/j.issn.1006-1959.2020.07.017]
点击复制

去甲肾上腺素在心肌梗死合并低血压中的应用()
分享到：

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
33卷
期数:
2020年07期
页码:
57-60
栏目:
论著
出版日期:
2020-04-01

文章信息/Info

Title:
Application of Norepinephrine in Myocardial Infarction with Hypotension
文章编号:
1006-1959（2020）07-0057-04
作者:
金 鹏; 周炳凤
（安徽医科大学第三附属医院/安徽省合肥市第一人民医院心血管内科，安徽 合肥 230061）
Author(s):
JIN Peng; ZHOU Bing-feng
(Department of Cardiology,the Third Affiliated Hospital of Anhui Medical University/the First People’s Hospital of Hefei City,Hefei 230061,Anhui,China)
关键词:
心肌梗死; 低血压; 去甲肾; 多巴胺; 预后
Keywords:
Myocardial infarction; Hypotension; Noradic kidney; Dopamine; Prognosis
分类号:
R542.2+2
DOI:
10.3969/j.issn.1006-1959.2020.07.017
文献标志码:
A
摘要:
目的 探讨去甲肾上腺素在急性心肌梗死（AMI）合并低血压中的应用效果。方法 选择2018年4月~2019年6月合肥市第一人民医院集团心血管内科收治的AMI合并低血压患者119例，采用随机数字表法分为去甲肾上腺组（n=63）和多巴胺组（n=56），比较两组治疗前后各时间点心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）、左室射血分数（LVEF）、血肌酐（Scr）、肌酸激酶同工酶（CK-MB）、肌钙蛋白Ⅰ（cTnⅠ）、尿量（UV）的水平。记录两组CCU住院期间、28 d及6个月病死率、冠心病重症监护室（CCU）住院时间、达到目标血压所需时间、心律失常发生率、IABP使用比率、胃肠道不良反应发生率、冠脉开通后TIMI血流分级。结果 两组CCU住院期间、28 d及6个月病死率比较，差异无统计学意义（P＞0.05）；两组治疗前血清Scr、SpO2、LVEF、CK-MB、cTnⅠ比较，差异无统计学意义（P＞0.05）；去甲肾上腺素组治疗后各时间点MAP、UV、SpO2、LVEF水平均高于多巴胺组（P＜0.05），HR、CK-MB、cTnⅠ、CCU住院时间、IABP使用率、达到目标血压所需时间、胃肠道不良反应发生率、冠脉开通后TIMI血流分级≤2级比例均低于多巴胺组，差异有统计学意义（P＜0.05）。结论 与多巴胺相比，去甲肾上腺素在用药早期即可稳定AMI合并低血压患者血流动力学、改善组织灌注，为进一步治疗争取时间，且不良反应少，值得临床应用。
Abstract:
Objective To explore the effect of norepinephrine on acute myocardial infarction with hypotension. Methods From April 2018 to June 2019, 119 patients with acute myocardial infarction and hypotension admitted to the Department of Cardiology of the First People’s Hospital of Hefei City were divided into norepinephrine group (n=63) and dopamine by random number table Group(n=56), compare snack rate (HR), mean arterial pressure (MAP), blood oxygen saturation (SpO2), left ventricular ejection fraction (LVEF), blood creatinine (Scr), Creatine kinase isoenzyme (CK-MB), troponin I (cTnI), urine output (UV) levels. Record the CCU hospitalization period, 28-day and 6-month mortality rate of the two groups, the length of hospital stay in the coronary heart disease intensive care unit (CCU), the time required to reach the target blood pressure, the incidence of arrhythmia, the use rate of IABP, the incidence of gastrointestinal adverse reactions, TIMI blood flow classification after coronary artery opening.Results There was no statistically significant difference in the mortality of CCU during hospitalization, 28 d and 6 months between the two groups (P>0.05); there was no significant difference in serum Scr, SpO2, LVEF, CK-MB, cTnⅠ between the two groups before treatment (P>0.05); MAP, UV,SpO2, LVEF levels at all time points after norepinephrine treatment were higher than dopamine group (P<0.05),HR, CK-MB, cTnⅠ,CCU hospital stay, IABP usage time required to reach the target blood pressure, the incidence of gastrointestinal adverse reactions, the proportion of TIMI blood flow grade≤2 after coronary artery opening were all lower than those in the dopamine group, the difference was statistically significant (P>0.05).Conclusion Compared with dopamine, norepinephrine can stabilize the hemodynamics and improve tissue perfusion of patients with acute myocardial infarction and hypotension in the early stage of medication, so as to gain time for further treatment and less adverse reactions.

参考文献/References:

[1]雍婧雯,王志坚,林徐泽,等.急性心肌梗死患者患病构成比及住院死亡率变化趋势[J].中华心血管病杂志,2019,47(3):209-214.[2]Jespersen L,Abildstrom SZ,Pena A,et al.Predictive value of the corrected TIMI frame count in patients with suspected angina pectoris but no obstructive coronary artery disease at angiography[J].Clinical Research in Cardiology,2014,103(5):381-387.[3]White CM,Chow MS,Fan C,et al.Efficacy of intravenous granisetron in suppressing the bradycardia and hypotension associated with a rabbit model of the Bezold-Jarisch reflex[J].Journal of Clinical Pharmacology,1998,38(2):172-777.[4]Morrow DA,Antman EM,Charlesworth A,et al.TIMI Risk Score for ST Elevation Myocardial Infarction:A Convenient, Bedside Clinical Score for Risk Assessment at Presentation:An Intravenous nPA for Treatment of Infarcting Myocardium EarlyⅡTrial Substudy[J].Circulation,2000(102):2031-2037. [5]张新超,于学忠,陈凤英,等.急性冠脉综合征急诊快速诊治指南(2019)[J].临床急诊杂志,2019,20(4):253-262.[6]Amado J,Gago P,Santos W,et al.Cardiogenic shock: Inotropes and vasopressors[J].Rev Port Cardiol,2016,35(12):681-695.[7]Levy B,Bastien O,Karim B,et al.Experts’ recommendations for the management of adult patients with cardiogenic shock[J].Annals of Intensive Care,2015,5(17):1-10.[8]高润霖.急性心肌梗死诊断和治疗指南[J].中国循环杂志,2001,29(6):710-725.[9]Babaev A,Frederick PD,Pasta DJ,et al.Trends in management andutcomesofatients with acute myocardial infarction complicated by cardiogenic shock[J].JAMA,2005,24(4):448-454.[10]胡怀岭,李群,姜椿法,等.急诊经皮冠状动脉介入术治疗急性心肌梗死患者术后低血压危险因素[J].临床荟萃,2015,30(1):13-16.[11]Chinese Medical Association.Guideline for diagnosisand treatment of acute ST - elevation myocardial infraction[J].Chin J Cardiol,2015,43(5):380-393.[12]Debaveye YA,Van den Berghe GH.Is There Still a Place for Dopamine in the Modern Intensive Care Unit?[J].Anesthesia & Analgesia,2004,98(2):461-468.[13]Cain SM,Curtis SE.Experimental models of pathologic oxygen supply dependency[J].Crit Care Med,1991,19(5):603-612.[14]周建达.去甲肾上腺素与多巴胺治疗感染性休克的疗效比较[J].中国药房,2015,26(27):3794-3796[15]谭照华.多巴胺与去甲肾上腺素在心源性休克中的应用比较[J].现代诊断与治疗,2016,27(13):2420-2421[16]李婧,陈汉想,李伟,等.心率与急性心肌梗死心源性休克发生率的关系[J].临床合理用药杂志,2014,7(1):19-21.[17]Nantais J,Dumbarton TC,Farah N,et al.Impact of methylene blue in addition to norepinephrine on the intestinal microcirculation in experimental septic shock[J].Clinical Hemorheology and Microcirculation,2014,58(1):97-105.[18]Di Giantomasso D,Morimatsu H,May CN,et al.Increasing renal blood flow:low-dose dopamine or me-dium-dose norepinephrine[J].Chest,2004,125(6):2260-2267.

相似文献/References:

[1]冯 湧.新一代抗凝血药阿加曲班的临床应用进展[J].医学信息,2018,31(02):43.[doi:10.3969/j.issn.1006-1959.2018.02.015]
　FENG Yong.Progress in Clinical Application of the New Generation Anticoagulant Agatripine[J].Medical Information,2018,31(07):43.[doi:10.3969/j.issn.1006-1959.2018.02.015]
[2]肖一红.组合型人工肾技术预防血液透析中低血压的效果观察[J].医学信息,2018,31(03):185.[doi:10.3969/j.issn.1006-1959.2018.03.070]
　XIAO Yi-hong.Effect of Combined Artificial Renal Technique in Preventing Hypotension in Hemodialysis[J].Medical Information,2018,31(07):185.[doi:10.3969/j.issn.1006-1959.2018.03.070]
[3]翟公伟,赵培华,滑 艳.30岁以下急性ST段抬高型心肌梗死患者临床特点分析[J].医学信息,2018,31(05):81.[doi:10.3969/j.issn.1006-1959.2018.05.026]
　ZHAI Gong-wei,ZHAO Pei-hua,HUA Yan.Clinical Characteristics of Acute ST-segment Elevation Myocardial Infarction under 30 Years of Age[J].Medical Information,2018,31(07):81.[doi:10.3969/j.issn.1006-1959.2018.05.026]
[4]杜浩珲.溶栓后PCI与pPCI治疗急性ST段抬高型心肌梗死的 临床效果研究[J].医学信息,2018,31(08):69.[doi:10.3969/j.issn.1006-1959.2018.08.021]
　DU Hao-hun.Clinical Effect of PCI and pPCI on Acute ST Segment Elevation Myocardial Infarction after Thrombolysis[J].Medical Information,2018,31(07):69.[doi:10.3969/j.issn.1006-1959.2018.08.021]
[5]宋俊燕,张 毅.重组人尿激酶原在急性ST段抬高型心肌梗死中的 疗效及并发症分析[J].医学信息,2018,31(11):133.[doi:10.3969/j.issn.1006-1959.2018.11.042]
　SONG Jun-yan,ZHANG Yi.Therapeutic Efficacy and Complications of Recombinant Human Pro-urokinase in Acute ST-elevation Myocardial Infarction[J].Medical Information,2018,31(07):133.[doi:10.3969/j.issn.1006-1959.2018.11.042]
[6]李 晶,黄 波.抗血小板药物治疗心血管疾病的研究现状[J].医学信息,2022,35(10):83.[doi:10.3969/j.issn.1006-1959.2022.10.020]
　LI Jing,HUANG Bo.Research Status of Antiplatelet Drugs in the Treatment of Cardiovascular Diseases[J].Medical Information,2022,35(07):83.[doi:10.3969/j.issn.1006-1959.2022.10.020]
[7]汤海霞,班 涛.大黄素与心血管疾病的研究[J].医学信息,2022,35(11):19.[doi:10.3969/j.issn.1006-1959.2022.11.006]
　TANG Hai-xia,BAN Tao.Research on Emodin and Cardiovascular Diseases[J].Medical Information,2022,35(07):19.[doi:10.3969/j.issn.1006-1959.2022.11.006]
[8]李素军.早期心脏康复运动治疗方案对急性非ST段抬高 心肌梗死的效果观察[J].医学信息,2018,31(15):89.[doi:10.3969/j.issn.1006-1959.2018.15.027]
　LI Su-jun.Effect of Early Cardiac Rehabilitation Exercise on Acute Non-ST-Elevation Myocardial Infarction[J].Medical Information,2018,31(07):89.[doi:10.3969/j.issn.1006-1959.2018.15.027]
[9]赵 立,褚海辰,梁永新.苯肾上腺素预输注防治老年人脊麻后低血压的临床研究[J].医学信息,2018,31(20):81.[doi:10.3969/j.issn.1006-1959.2018.20.023]
　ZHAO Li,CHU Hai-chen,LIANG Yong-xin.Clinical Study of Phenylephrine Pre-infusion for Prevention and Treatment of Hypotension after Spinal Anesthesia in the Elderly[J].Medical Information,2018,31(07):81.[doi:10.3969/j.issn.1006-1959.2018.20.023]
[10]王 铮.不同院前急救方式对心肌梗死后急性左心衰竭救治效果及预后的影响[J].医学信息,2022,35(12):169.[doi:10.3969/j.issn.1006-1959.2022.12.042]
　WANG Zheng.Effect of Different Pre-hospital Emergency Methods on Treatment and Prognosis of Acute Left Heart Failure After Myocardial Infarction[J].Medical Information,2022,35(07):169.[doi:10.3969/j.issn.1006-1959.2022.12.042]

更新日期/Last Update: 2020-04-01