Hackett D, Davies G, Maseri A
Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, U.K.
Eur Heart J. 1988 Jan;9 Suppl A:151-3. doi: 10.1093/eurheartj/9.suppl_a.151.
We have investigated the coronary vasodilator responses to nitrates in the early stages of acute myocardial infarction before, during and after the administration of thrombolytic therapy. Before thrombolysis, intracoronary doses (2-4 mg) of isosorbide dinitrate failed to induce recanalisation of the totally occluded infarct related artery. Episodes of coronary reopening and reocclusion associated with ST-segment resolution and re-elevation were frequently observed both spontaneously before and during thrombolytic therapy. In 50-86% of patients, intracoronary isosorbide dinitrate promptly re-established full coronary patency immediately after acute reocclusion or whenever coronary occlusion was incomplete, both before and during thrombolysis. After thrombolysis further intracoronary isosorbide dinitrate dilated the infarct related stenoses but not uninvolved adjacent normal coronary branches. Coronary thrombosis and constriction frequently interact during the early phases of acute myocardial infarction. The combination of high local concentrations of nitrates with thrombolytic agents promotes stable coronary recanalization and may be beneficial in patients with acute myocardial infarction.
我们研究了在急性心肌梗死早期，在溶栓治疗前、治疗期间及治疗后，硝酸盐对冠状动脉的舒张反应。溶栓前，冠状动脉内给予二硝酸异山梨酯剂量为2 - 4mg时，未能使完全闭塞的梗死相关动脉再通。在溶栓治疗前及治疗期间，常自发观察到与ST段回落和再次抬高相关的冠状动脉再开放和再闭塞情况。在50% - 86%的患者中，冠状动脉内给予二硝酸异山梨酯后，无论在溶栓前还是溶栓期间，急性再闭塞后或冠状动脉闭塞不完全时，均可迅速重新建立冠状动脉完全通畅。溶栓后，进一步冠状动脉内给予二硝酸异山梨酯可扩张梗死相关狭窄，但对未受累的相邻正常冠状动脉分支无扩张作用。在急性心肌梗死早期，冠状动脉血栓形成和血管收缩常相互作用。高局部浓度的硝酸盐与溶栓剂联合使用可促进冠状动脉稳定再通，可能对急性心肌梗死患者有益。
