[1]杨萌萌 王引利.去甲肾上腺素与多巴胺对急性心肌梗死后低血压状态应用比较的研究进展[J].心血管病学进展,2023,(10):955.[doi:10.16806/j.cnki.issn.1004-3934.2023.10.020]
　YANG Mengmeng,WANG Yinli.Comparison of the Effects Between Norepinephrine and Dopamine on Hypotension after Acute Myocardial Infarction[J].Advances in Cardiovascular Diseases,2023,(10):955.[doi:10.16806/j.cnki.issn.1004-3934.2023.10.020]
点击复制

去甲肾上腺素与多巴胺对急性心肌梗死后低血压状态应用比较的研究进展()
分享到：

《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2023年10期
页码:
955
栏目:
论著
出版日期:
2023-10-25

文章信息/Info

Title:
Comparison of the Effects Between Norepinephrine and Dopamine on Hypotension after Acute Myocardial Infarction
作者:
杨萌萌 王引利
(西南交通大学附属医院 成都市第三人民医院心内科 成都市心血管病研究所,四川 成都 610031)
Author(s):
YANG Mengmeng; WANG Yinli
(Department of Cardiology,The Third People’s Hospital of Chengdu,Chengdu Institute of Cardiovascular Diseases,The Affiliated Hospital of Southwest Jiaotong University,Chengdu,610031,Sichuan,China)
关键词:
急性心肌梗死; 低血压; 去甲肾上腺素; 多巴胺
Keywords:
Acute myocardial infarction;  Hypotension;  Norepinephrine;  Dopamine
DOI:
10.16806/j.cnki.issn.1004-3934.2023.10.020
摘要:
目的 评估去甲肾上腺素（NE）和多巴胺（DA）在治疗急性心肌梗死（AMI）后低血压状态有效性及安全性。方法 采用回顾性队列研究方法，以成都市第三人民医院心内科2013年1月—2021年12月收治的全部AMI低血压状态患者，住院期间使用NE及DA自然分组，通过电子病案查询系统，采集患者基础临床资料，及用药后6 h、12 h的血压、心率、是否发生心律失常、是否院内死亡等数据。结果 通过纳排标准，总共纳入患者120例，NE组72例，DA组48例。两组患者基本临床基线情况无统计学差异（P0.05）；用药前、用药6 h、用药12 h各时间点心率无统计学差异（P0.05），用药6 h血压有统计学差异（P＜0.05）。住院期间，两组患者心律失常发生率无统计学差异（χ2=0.002,P=0.964），两组患者死亡率有统计学差异（χ2=6.429P=0.011）。对不同结局患者进行单因素分析，发现高敏肌钙蛋白T、再血管化时间、男性比例、发生率、2型糖尿病发生率、ST段抬高发生率无统计学差异（0.05）；年龄、左室射血分数、脑利钠肽、肌酐、低密度脂蛋白、血钾、白蛋白、前壁心肌梗死发生率、再血管化率、DA使用率有统计学差异（P＜0.05）。多元logistic回归分析显示使用NE较使用DA降低院内死亡风险（OR=0.177,P=0.013），前壁心肌梗死增加院内死亡风险（OR=9.268,P=0.005），再血管化治疗降低院内死亡风险（OR=0.139,P=0.007）。结论 AMI后低血压状态患者，使用NE与DA升压效果相当，但NE安全性更高，是该类患者更优选择。
Abstract:
Objective To compare the efficacy and safety of norepinephrine (NE) and dopamine (DA) on hypotension after acute myocardial infarction (AMI). Methods A retrospective cohort study method was used. The basic clinical data of AMI patients with hypotension admitted to our department from January 2013 to December 2021,and blood pressure,heart rate,whether complicated by arrhythmia or death in hospital at 6 hours and 12 hours after medication,were collected by electronic medical record inquiry system,and naturally grouped by DA and NE during hospitalization. Result According to the inclusion and exclusion criteria,a total of 120 patients were enrolled,including 72 in NE group and 48 in DA group. There was no statistical difference in clinical baseline characteristics and heart rate between the two groups (P≥0.05),but a difference in blood pressure was presented (P＜0.05). During hospitalizationthere was no significant difference in the incidence of arrhythmia between the two groups (χ2=0.002,P=0.964),but a difference in mortality rates was presented (χ2=6.429,P=0.011). Univariate analysis of patients with different outcomes showed that there was no statistical difference in troponin T,revascularization time,male ratio,incidence of hypertension,T2DM,and STEMI between the two groups (P≥0.05),but differences in age,left ventricular ejection fraction,brain natriuretic peptide,creatinine,low-density lipoprotein,blood potassium,albumin,incidence of anterior myocardial infarction,revascularization rate,and DA utilization rate were existed (P<0.05). Multiple logistic regression analysis showed NE decreased the risk of death in hospital compared with DA (OR=0.177,P=0.013). Anterior myocardial infarction increased (OR=9.268,P=0.005) while the revascularization therapy decreased (OR=0.139,P=0.007) the risk of death in hospital. Conclusion In patients with hypotension after AMI,NE and DA exerted the similar vasopressor effects,while NE showed up a higher safety so it would be a better choice for these patients.

参考文献/References:

[1]陈强,陈应忠,蒋兴林,等. 80岁及以上高龄急性ST段抬高型心肌梗死接受不同治疗方式的预后差异[J].中国老年学杂志,2022,(5):1029-1032.
[2]Cho JY,Jeong MH,Ahn YK,et al. Comparison of outcomes of patients with painless versus painful ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention[J].Am J Cardiol,2012,109(3):337-343.
[3]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性心肌梗死合并心原性休克诊断和治疗中国专家共识(2021)[J].中华心血管病杂志,2022,50(3):.
[4] 中华医学会心血管病学分会心血管急重症学组,中华心血管病杂志编辑委员会. 心原性休克诊断和治疗中国专家共识(2018)[J]. 中华心血管病杂志,2019,47(4):.?
[5]Zeymer U,Bueno H,Granger CB,et al. Acute Cardiovascular Care Association position statement for the diagnosis and treatment of patients with acute myocardial infarction complicated by cardiogenic shock: a document of the Acute Cardiovascular Care Association of the European Society of Cardiology[J]. Eur Heart J Acute Cardiovasc Care,2020,9(2):183-197.
[6]中华医学会心血管病学分会,中华心血管病杂志编辑委员会. 急性ST段抬高型心肌梗死诊断和治疗指南(2019)[J]. 中华心血管病杂志,2019,47(10):766-783.
[7] Collet JP,Thiele H,Barbato E,et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation[J].Eur Heart J,2021,42(14):1289-1367.
[8] 赵连友,孙英贤,李悦,等.经皮冠状动脉介入治疗术后血压管理中国专家共识[J].中华高血压杂志,2022,30(6):.
[9]Goldstein JA,Lee DT,Pica MC,et al.Patterns of coronary compromise leading to bradyarrhythmias and hypotension in inferior myocardial infarction[J].Coron Artery Dis,2005,16(5):265-274.
[10] 刘永兴,贾大林,齐国先,等.急诊经皮冠状动脉介入治疗中梗死相关动脉再通后低血压的相关因素分析[J].中国介入心脏病学杂志,2007,15(6):4.
[11]P?ss J,K?ster J,Fuernau G,et al. Risk stratification for patients in cardiogenic shock after acute myocardial infarction[J]. J Am Coll Cardiol,2017,69(15):1913-1920.
[12]China Society of Cardiology of Chinese Medical Association, Editorial Board of Chinese Journal of Cardiology.Guideline on the diagnosis and therapy of ST-segment elevation myocardial infarction[J].Zhonghua Xin Xue Guan Bing Za Zhi,2015,43(5):380.
[13]Havel C.Comparison of dopamine and norepinephrine in the treatment of shock—NEJM[J].Mdica,2010,5(1):69.

相似文献/References:

[1]林远龙,刘现亮.无复流现象:从基础到临床[J].心血管病学进展,2016,(1):53.[doi:10.16806/j.cnki.issn.1004-3934.2016.01.014]
　LIN Yuanlong,LIU Xianliang.From Bench to Bed:No-reflow Phenomenon[J].Advances in Cardiovascular Diseases,2016,(10):53.[doi:10.16806/j.cnki.issn.1004-3934.2016.01.014]
[2]赵劲东,综述,董平栓,等.合并多支血管病变的急性ST段抬高型心肌梗死介入术治疗策略的研究进展[J].心血管病学进展,2016,(3):295.[doi:10.16806/j.cnki.issn.1004-3934.2016.03.021]
　ZHAO Jindong,DONG Pingshuan.Research Progress of Interventional Therapy in Patients with ST-elevation Myocardial Infarction and Multivessel Disease[J].Advances in Cardiovascular Diseases,2016,(10):295.[doi:10.16806/j.cnki.issn.1004-3934.2016.03.021]
[3]余正春,综述,马小静,等.急性心肌梗死并发心源性休克的治疗进展[J].心血管病学进展,2016,(4):441.[doi:10.16806/j.cnki.issn.1004-3934.2016.04.029]
　YU Zhengchun,MA Xiaojing.Treatment of Cardiogenic Shock Complicating Acute Myocardial Infarction[J].Advances in Cardiovascular Diseases,2016,(10):441.[doi:10.16806/j.cnki.issn.1004-3934.2016.04.029]
[4]袁帅,毛玉琳,钱志敏,等.经皮冠脉介入术在高龄老年患者治疗中的研究新进展[J].心血管病学进展,2019,(6):864.[doi:10.16806/j.cnki.issn.1004-3934.2019.06.007]
　YUAN Shuai,MAO Yulin,QIAN Zhimin,et al.New Progress in Study of PCI in treatment of Elderly Patients[J].Advances in Cardiovascular Diseases,2019,(10):864.[doi:10.16806/j.cnki.issn.1004-3934.2019.06.007]
[5]元洋洋 李波.Selvester QRS评分系统研究进展[J].心血管病学进展,2019,(7):985.[doi:10.16806/j.cnki.issn.1004-3934.2019.07.005]
　YUAN YangyangLI Bo.Research Progress of Selvester QRS Scoring System[J].Advances in Cardiovascular Diseases,2019,(10):985.[doi:10.16806/j.cnki.issn.1004-3934.2019.07.005]
[6]翁子骞 于波.血栓抽吸在急性ST段抬高型心肌梗死中的研究进展[J].心血管病学进展,2019,(7):1035.[doi:10.16806/j.cnki.issn.1004-3934.2019.07.018]
　WENG ZiqianYU Bo.Thrombus aspiration in acute ST-segment elevation myocardial infarction[J].Advances in Cardiovascular Diseases,2019,(10):1035.[doi:10.16806/j.cnki.issn.1004-3934.2019.07.018]
[7]林莉 韦铁民.急性心肌梗死后心脏破裂[J].心血管病学进展,2019,(7):1039.[doi:10.16806/j.cnki.issn.1004-3934.2019.07.019]
　LIN LiWEI Tiemin.Post-infarction Cardiac Rupture[J].Advances in Cardiovascular Diseases,2019,(10):1039.[doi:10.16806/j.cnki.issn.1004-3934.2019.07.019]
[8]杨颜瑜,苏星,谭敏,等.炎症指标与急性心肌梗死研究进展[J].心血管病学进展,2019,(6):947.[doi:10.16806/j.cnki.issn.1004-3934.2019.0.027]
　YANG Yanyu,SU Xing,TAN Min,et al.Relationship Between Inflammation Index and Acute Myocardial Infarction[J].Advances in Cardiovascular Diseases,2019,(10):947.[doi:10.16806/j.cnki.issn.1004-3934.2019.0.027]
[9]崔小豪 杨志明.和肽素在急性心肌梗死中的研究进展[J].心血管病学进展,2019,(5):726.[doi:10.16806/j.cnki.issn.1004-3934.2019.05.016]
　CUI Xiaohao,YANG Zhiming.Copeptin in Acute Myocardial Infarction[J].Advances in Cardiovascular Diseases,2019,(10):726.[doi:10.16806/j.cnki.issn.1004-3934.2019.05.016]
[10]潘甜 马康华.急性心肌梗死经皮冠脉介入术后冠状动脉无复流的预防和治疗进展[J].心血管病学进展,2019,(5):730.[doi:10.16806/j.cnki.issn.1004-3932019.05.017]
　PAN Tian,MA Kanghua.Prevention and Treatment of Coronary Artery No-Reflow after Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction[J].Advances in Cardiovascular Diseases,2019,(10):730.[doi:10.16806/j.cnki.issn.1004-3932019.05.017]

备注/Memo

备注/Memo:
收稿日期:2023-01-05基金项目：四川省E-mail:714689546@qq.com
更新日期/Last Update: 2023-11-15