Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada.
Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada.
Am Heart J. 2014 Nov;168(5):776-83. doi: 10.1016/j.ahj.2014.07.009. Epub 2014 Jul 24.
Experimental evidence suggests that the inhalational anesthetic sevoflurane has a cardioprotective effect. Our objective was to determine if sedation with sevoflurane will reduce infarct size in patients with acute myocardial infarction (MI) who are treated with primary percutaneous coronary intervention (PCI).
We randomized 50 patients presenting with a first acute ST-elevation MI treated by primary PCI within 6 hours from symptom onset to sedation with sevoflurane inhalation or standard sedation (control). Coronary flow at the end of PCI was assessed by corrected Thrombolysis In Myocardial Infarction frame count. Myocardial reperfusion was assessed by ST-segment resolution 60 minutes post-PCI. Infarct size was assessed by release of creatinine kinase (CK) and troponin T.
There was no difference in the primary end point: troponin T or CK release adjusted to the area at risk, between groups. However, among patients with anterior MI, there was a trend toward lower CK (P = .05) and nonsignificant decrease in troponin (P = .11) levels in the sevoflurane group. Corrected Thrombolysis In Myocardial Infarction frame count was 12.3 ± 1.5 in the sevoflurane group and 15.6 ± 9.1 in the control group (P = .16). There was more ST resolution in patients treated by sevoflurane 80.7% ± 25.8% versus 56.6% ± 35.7% (P = .01). Sevoflurane had no significant adverse effect during administration.
Sevoflurane administration during primary PCI did not reduce infarct size. There was a trend toward a reduction in infarct size among patients with anterior MI. Sevoflurane administration was associated with improvement in ST-segment resolution.
实验证据表明，吸入麻醉剂七氟醚具有心脏保护作用。我们的目的是确定在接受直接经皮冠状动脉介入治疗（PCI）的急性心肌梗死（MI）患者中，七氟醚镇静是否会减少梗死面积。
我们将 50 名出现急性 ST 段抬高 MI 的患者随机分为两组，在症状发作后 6 小时内接受直接 PCI 治疗，一组给予七氟醚吸入镇静（七氟醚组），另一组给予标准镇静（对照组）。通过校正溶栓治疗心肌梗死帧数评估 PCI 结束时的冠脉血流。通过 PCI 后 60 分钟 ST 段回落评估心肌再灌注。通过肌酸激酶（CK）和肌钙蛋白 T 的释放评估梗死面积。
两组间主要终点（校正后风险面积的肌钙蛋白 T 或 CK 释放）无差异。然而，在前壁心肌梗死患者中，七氟醚组 CK（P =.05）和肌钙蛋白（P =.11）水平有降低趋势。七氟醚组校正溶栓治疗心肌梗死帧数为 12.3 ± 1.5，对照组为 15.6 ± 9.1（P =.16）。七氟醚组患者 ST 段回落更多 80.7% ± 25.8% vs 56.6% ± 35.7%（P =.01）。七氟醚在使用过程中没有明显的不良反应。
直接 PCI 期间给予七氟醚镇静并不能减少梗死面积。在前壁心肌梗死患者中，梗死面积有减小趋势。七氟醚的使用与 ST 段回落的改善相关。
