刘晶晶,曲涛,张萌,靳维华,高炬,王斌

• 1:北京大学航天临床医学院
• 2:航天中心医院心脏中心

摘要(Abstract)：

目的经外周静脉(手背静脉)泵入腺苷三磷酸(ATP)的方法测定血流储备分数(FFR),并通过与标准的测量方法[深静脉(股静脉)泵入ATP]测量FFR的对比研究,评价经外周静脉泵入不同剂量ATP测定FFR的可行性。探讨经手背静脉泵入ATP测定是否能够准确测量FFR。方法针对航天中心医院27例患者冠状动脉造影术中的31条冠状动脉病变血管,进行外周静脉和股静脉冠状动脉造影术及两种途径测定的FFR数值测量与数据分析。结果经手背静脉泵入ATP[≥140μg/(kg·min)]测量的4组FFR值与标准方法测量FFR值的一致性、相关性。两种途径注射ATP后心率、PR间期、不良反应发生率比较,差异无统计学意义。但手背静脉ATP注射剂量为160μg/(kg·min)时,FFR测量结果与股静脉组FFR结果一致性与相关性最好(R2=0.904,P=0.001)。经手背静脉泵入ATP达FFR值时间[从(53.7±15.8)s到(58.2±11.6)s]较标准方法[(48.7±17.9)s]延长(P=0.015)。结论经手背静脉泵入ATP测量FFR值可与标准方法取得相似的结果,使用手背静脉注射ATP[剂量160μg/(kg·min)]测量冠状动脉FFR具有临床实用价值。

关键词(KeyWords)： 血流储备分数;外周静脉;腺苷三磷酸

Abstract:

Keywords:

基金项目(Foundation): 首都卫生发展专项课题(首发2011-6031-03)

作者(Author): 刘晶晶,曲涛,张萌,靳维华,高炬,王斌

参考文献(References)：

• [1]Kern MJ,Deligonul U,Tatineni S,et al.Intravenous adenosine:continuous infusion and low dose bolus administration for determination of coronary vasodilator reserve in patients with and without coronary artery disease.J Am Coll Cardiol,1991,18:718-729.
• [2]Pijls NH,van Son JA,Kirkeeide RL,et al.Experimental basis of determining maximum coronary,myocardial,and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty.Circulation,1993,87:1354-1367.
• [3]Rossen JD,Quillen JE,Lopez AG,et al.Comparison of coronary vasodilation with intravenous dipyridamole and adenosine.J Am Coll Cardiol,1991,18:485-491.
• [4]Wilson RF,White CW.Intracoronary papaverine:an ideal coronary vasodilator for studies of the coronary circulation in conscious humans.Circulation,1986,73:444-451.
• [5]van der Voort PH,van Hagen E,Hendrix G,et al.Comparison of intravenous adenosine to intracoronary papaverine for calculation of pressure-derived fractional fl ow reserve.Cathet Cardiovasc Diagn,1996,39:120-125.
• [6]De Bruyne B,Pijls NH,Barbato E,et al.Intracoronary and intravenous adenosine 5'-triphosphate,adenosine,papaverine,and contrast medium to assess fractional flow reserve in humans.Circulation,2003,107:1877-1883.
• [7]Sonoda S,Takeuchi M,Nakashima Y,et al.Safety and optimal dose of intracoronary adenosine 5'-triphosphate for the measurement of coronary flow reserve.Am Heart J,1998,135:621-627.
• [8]Yamada H,Azuma A,Hirasaki S,et al.Intracoronary adenosine 5'-triphosphate as an alternative to papaverine for measuring coronary flow reserve.Am J Cardiol,1994,74:940-941.
• [9]Inoue F,Hashimoto T,Fujimoto S,et al.Estimation of coronary fl ow reserve by intracoronary administration of nicorandil:comparison with intracoronary administration of papaverine.Heart Vessels,1998,13:229-236.
• [10]Rudzinski W,Waller AH,Rusovici A,et al.Comparison of effi cacy and safety of intracoronary sodium nitroprusside and intravenous adenosine for assessing fractional fl ow reserve.Catheter Cardiovasc Interv,2013,81:540-544.
• [11]De Bruyne B,Pijls NH,Barbato E,et al.Intracoronary and intravenous adenosine 5'-triphosphate,adenosine,papaverine,and contrast medium to assess fractional flow reserve in humans.Circulation,2003,107:1877-1883.
• [12]Rongen GA,Smits P,Thien T.Effects of intravenous and intracoronary adenosine 5'-triphosphate as compared with adenosine on coronary flow and pressure dynamics.Circulation,2001,103:e58.
• [13]Seo MK,Koo BK,Kim JH,et al.Comparison of hyperemic efficacy between central and peripheral venous adenosine infusion for fractional flow reserve measurement.Circ Cardiovasc Interv,2012,5:401-405.
• [14]Lindstaedt M,Bojara W,Holland-Letz T,et al.Adenosine-induced maximal coronary hyperemia for myocardial fractional flow reserve measurements:comparison of administration by femoral venous versus antecubital venous access.Clin Res Cardiol,2009,98:717-723.