Johnston D L, Daley J R, Hodge D O, Hopfenspirger M R, Gibbons R J
Division of Cardiovascular Diseases, Mayo Clinic Rochester, MN 55905.
Mayo Clin Proc. 1995 Apr;70(4):331-6. doi: 10.4065/70.4.331.
To compare the hemodynamic responses and the adverse effects associated with two coronary vasodilators used for pharmacologic stress testing.
We retrospectively studied the results of adenosine and dipyridamole perfusion imaging in a large group of patients who underwent pharmacologic stress radionuclide perfusion imaging.
One thousand patients given dipyridamole between April 1989 and April 1991 (before adenosine became available) were compared with 1,000 patients given adenosine between April 1991 and October 1992. A standard protocol was used to infuse the drugs before myocardial perfusion imaging with 201Tl or 99mTc sestamibi.
Peak heart rate was higher (85 versus 83 beats/min; P = 0.02) and systolic blood pressure was lower (129 versus 133 mm Hg; P < 0.0001) with adenosine than with dipyridamole. More patients had a decrease in systolic blood pressure of 30 mm Hg or more with adenosine than with dipyridamole (P = 0.002). Horizontal or downsloping ST-segment depression of 1 mm or more occurred in 9% of patients who received adenosine and in 8% of those who received dipyridamole. Adverse effects occurred in 78% of the adenosine study group and in 50% of the dipyridamole group (P < 0.0001). Chest pain was the most common symptom with both drugs. Atrioventricular block occurred in 76 patients who received adenosine but in none who received dipyridamole. Because of adverse effects, 28% of patients who received dipyridamole required extra monitoring time (mean, 6 +/- 5 minutes beyond the standard protocol). Aminophylline was administered to 163 and 6 patients, respectively, in the dipyridamole and adenosine study groups.
Adenosine causes slightly greater systemic vasodilation than does dipyridamole. Adverse effects occur less often with dipyridamole but, in comparison with adenosine, are more difficult to manage and necessitate more monitoring time as well as fairly frequent intravenous use of aminophylline for reversal.
比较两种用于药物负荷试验的冠状动脉血管扩张剂的血流动力学反应及不良反应。
我们回顾性研究了一大组接受药物负荷放射性核素灌注成像患者的腺苷和双嘧达莫灌注成像结果。
将1989年4月至1991年4月（腺苷可用之前）接受双嘧达莫治疗的1000例患者与1991年4月至1992年10月接受腺苷治疗的1000例患者进行比较。在使用201Tl或99mTc 甲氧基异丁基异腈进行心肌灌注成像前，采用标准方案输注药物。
与双嘧达莫相比，腺苷使心率峰值更高（85对83次/分钟；P = 0.02），收缩压更低（129对133 mmHg；P < 0.0001）。与双嘧达莫相比，更多接受腺苷治疗的患者收缩压下降30 mmHg或更多（P = 0.002）。接受腺苷治疗的患者中有9%出现水平或下斜型ST段压低1 mm或更多，接受双嘧达莫治疗的患者中有8%出现这种情况。腺苷研究组78%的患者出现不良反应，双嘧达莫组为50%（P < 0.0001）。胸痛是两种药物最常见的症状。接受腺苷治疗的76例患者发生房室传导阻滞，而接受双嘧达莫治疗的患者无一发生。由于不良反应，接受双嘧达莫治疗的患者中有28%需要额外的监测时间（平均比标准方案超出6±5分钟）。双嘧达莫和腺苷研究组分别有163例和6例患者使用了氨茶碱。
腺苷引起的全身血管扩张比双嘧达莫略大。双嘧达莫不良反应的发生率较低，但与腺苷相比，更难处理，需要更多的监测时间，并且需要相当频繁地静脉使用氨茶碱来逆转不良反应。
