MARKED SYSTEMIC HYPOTENSION DEPRESSES CORONARY THROMBOLYSIS INDUCED BY INTRACORONARY ADMINISTRATION OF RECOMBINANT TISSUE-TYPE PLASMINOGEN-ACTIVATOR
MARKED SYSTEMIC HYPOTENSION DEPRESSES CORONARY THROMBOLYSIS INDUCED BY INTRACORONARY ADMINISTRATION OF RECOMBINANT TISSUE-TYPE PLASMINOGEN-ACTIVATOR
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DOI：
10.1016/0735-1097(92)90459-z
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发表时间：
1992-12-01
影响因子：
24
通讯作者：
DUCAS, J
中科院分区：
文献类型：
--
作者：
PREWITT, RM;GU, SA;DUCAS, J
目标。本研究旨在验证主动脉血压水平影响冠状动脉内注射重组组织型纤溶酶原激活剂(rt-PA)所致冠状动脉血栓形成的速度和程度的假说。虽然许多研究已经证实了溶栓治疗急性心肌梗死的疗效，但血压变化对冠状动脉溶栓的影响还没有研究。由于主动脉压代表冠状动脉流入压，第一性原理预测，血压的变化会影响溶栓剂的输送，从而影响溶栓。在一种犬模型上研究了血压的大幅变化对冠状动脉溶栓的影响。经冠状动脉左前降支导管注入放射性血块诱导冠状动脉血栓形成。随后，24只犬被分成3组，每组8只：1组犬接受静脉切开术，将收缩压调整到130 mm Hg；2组狗接受静脉切开术，将收缩压降至75 mm Hg。第三组的狗也接受了静脉切开术，使其收缩压达到75毫米汞柱，然后接受去甲肾上腺素治疗，将血压提高到130毫米汞柱。调整血压后，所有犬均经左前降支导管30min内注入rt-PA(0.25 mg/kg体重)。在第四组的6只狗中，评估了血压变化对冠状动脉溶栓率的影响。第1组和第3组犬的冠脉溶栓率和溶栓率均显著高于第2组。第4组犬中，当去甲肾上腺素使收缩压从75 mm升高到130 mm时，冠脉溶栓率均增加。这些结果表明，与明显的全身性低血压相比，适度增加冠脉流入压可以增加冠脉溶栓的速度和程度。
Objectives. This study was designed to test the hypothesis that the level of aortic blood pressure affects the rate and extent of coronary thrombolysis induced by intracoronary administration of recombinant tissue-type plasminogen activator (rt-PA).Background. Although many studies have confirmed the efficacy of thrombolytic therapy in the treatment of acute myocardial infarction, the effects of altered blood pressure on coronary thrombolysis have not been studied. Because the aortic pressure represents the coronary artery inflow pressure, first principles predict that changes in blood pressure will affect the delivery of the thrombolytic agent and thus affect thrombolysis.Methods. The effects of large changes in blood pressure on coronary thrombolysis were studied in a canine model. Coronary thrombosis was induced by injection of radioactive blood clot through a catheter placed in the left anterior descending coronary artery. Subsequently, 24 dogs were classified into three groups of 8 dogs each: Group 1 dogs underwent phlebotomy to adjust systolic blood pressure to 130 mm Hg; Group 2 dogs underwent phlebotomy to decrease systolic blood pressure to 75 mm Hg. Dogs in Group 3 also underwent phlebotomy to achieve a systolic blood pressure of 75 mm Hg and then received norepinephrine to increase this pressure to 130 mm Hg. After adjustment in blood pressure, all dogs received an infusion of rt-PA (0.25 mg/kg body weight) over 30 min through the left anterior descending artery catheter. In a fourth group of six dogs, the effect of altered blood pressure on the rate of coronary thrombolysis was assessed.Results. In dogs in Groups 1 and 3, the rate and extent or coronary thrombolysis were significantly increased compared with values in Group 2. In each of the six Group 4 dogs the rate of coronary thrombolysis increased when norepinephrine increased systolic blood pressure from 75 to 130 mm Hg.Conclusions. These results indicate that a moderate increase in coronary inflow pressure increases the rate and extent of coronary thrombolysis compared with values during marked systemic hypotension.