Koren G, Weiss A T, Ben-David Y, Hasin Y, Luria M H, Gotsman M S
Am Heart J. 1986 Sep;112(3):468-71. doi: 10.1016/0002-8703(86)90508-9.
Acute myocardial infarction, particularly of the inferior wall, is frequently associated with bradycardia and hypotension. This study reports the occurrence of transient bradycardia hypotension (TBH) (Bezold-Jarisch reflex) following thrombolytic therapy with intravenous streptokinase. Of the 52 patients, 42 had successful reperfusion, and 12 of the latter developed reflex TBH. The Bezold-Jarisch reflex occurred in 10 of 24 patients with inferior wall acute myocardial infarction and in 2 of 28 patients with anterior wall infarction (p less than 0.05). The reflex was associated with significantly more non-Q wave infarctions (p less than 0.05) and also with reduction of left ventricular damage, as evidenced by a lower QRS score (4 +/- 3.8 vs 8.9 +/- 5.6, p less than 0.01) and a higher ejection fraction (61 +/- 13% vs 49 +/- 16%, p less than 0.05). Patients with inferior wall acute myocardial infarction were divided into those with TBH (10 patients) and those without TBH (14 patients). TBH was associated with a significantly higher infarct-related regional ejection fraction (60 +/- 19% vs 35 +/- 18%, p less than 0.05). The results of this study confirm previous findings that reperfusion of the inferoposterior myocardium is capable of stimulating reflex TBH. Furthermore, TBH is associated with patency of infarct-related coronary arteries and myocardial salvage.
急性心肌梗死，尤其是下壁心肌梗死，常伴有心动过缓和低血压。本研究报告了静脉注射链激酶溶栓治疗后出现的短暂性心动过缓低血压（TBH）（贝佐尔德-雅里什反射）。52例患者中，42例再灌注成功，其中12例发生了反射性TBH。24例下壁急性心肌梗死患者中有10例出现贝佐尔德-雅里什反射，28例前壁梗死患者中有2例出现该反射（p<0.05）。该反射与更多的非Q波梗死显著相关（p<0.05），也与左心室损伤减轻相关，表现为较低的QRS评分（4±3.8对8.9±5.6，p<0.01）和较高的射血分数（61±13%对49±16%，p<0.05）。下壁急性心肌梗死患者分为有TBH组（10例）和无TBH组（14例）。TBH与梗死相关区域的射血分数显著较高相关（60±19%对35±18%，p<0.05）。本研究结果证实了先前的发现，即下后壁心肌再灌注能够刺激反射性TBH。此外，TBH与梗死相关冠状动脉的通畅和心肌挽救相关。
