冠状动脉内单用替罗非班与联合应用山莨菪碱对急性心肌梗死经皮冠状动脉介入治疗后无再流现象影响的对比研究  

Combining intracoronary use of anisodamine and tirofiban to reverse the no-reflow phenomenon after-PCI of acute myocardial infarction

作　　者：范卫泽[1] 傅向华[1] 谷新顺[1] 姜云发[1] 吴伟力[1] 李世强[1] 刘君[1] 郝国桢[1] 薛玲[1] 李亮[1] 

机构地区：[1]河北医科大学附属第二医院干部心血管病房,石家庄050000

出　　处：《临床心血管病杂志》2007年第6期423-426,共4页Journal of Clinical Cardiology

摘　　要：目的:探讨冠状动脉内联合应用山莨菪碱和替罗非班对逆转急性心肌梗死(AMI)介入治疗后无再流的可行性、安全性及临床疗效。方法:行冠状动脉介入治疗的AMI患者252例,发生无再流47例,随机分为A组(替罗非班组)和B组(盐酸山莨菪碱联合替罗非班组),观察冠状动脉内SBP、DBP、MBP、HR、肺毛细血管楔压(PCWP)、左室舒张末期压力(LVEDP)、TIMI血流及TIMI血流计帧数的变化以及住院期间及术后1个月的主要心脏不良事件发生率。结果:A组冠状动脉内用药后SBP、DBP、MBP、HR、LVEDP及PCWP无明显变化,而B组用药后冠状动脉内SBP、DBP、MBP、HR明显升高(P<0.05或P<0.01),LVEDP及PCWP降低,但与用药前及A组比较差异无统计学意义;2组均明显改善TIMI血流及TIMI血流计帧数,B组效果更明显,均P<0.01。2组住院期间及术后1个月均无死亡、再次心肌梗死、再次血运重建、心绞痛等主要心脏不良事件发生。结论:冠状动脉内联合应用盐酸山莨菪碱和替罗非班可显著逆转AMI后无再流,不增加恶性心律失常和出血并发症的发生。Objective：To evaluate the feasibility, safety and clinical effect of intracoronary combining use of anisodamine and tirofiban on the reversing of no-fellow phenomenon after percutaneous coronary intervention （PCI） of acute myocardial infartion（AMI）. Method：Of 252 patients with AMI, forty-seven patients who had suffered no-reflow phenomena after-PCI were randomized into two groups： Group A （tirofiban group）and group B （combining use of anisodamine and tirofiban group） to observe the changes of invasive intracoronary pressure, heart rate, LVEDP, PCWP, the TIMI flow, the TIMI flow frame counting and incidence rate of MACE in-hospital in one month after-PCI. Result：There was no significant influence on the invasive intracoronary pressure, heart rate, LVEDP and PCWP in the group A, while the intracoronary pressure, heart rate were increased significantly in group B（P〈0.05 or P〈0. 01） ; LVEDP as well as PCWP was decreased in group B but no significance compared with that in group A. The TIMI flow and TIMI flow frame counting were both improved in the two groups and the effectivity in group B was more than that in group A, （P〈0.01）. There were no main adverse cardiac events such as death, reinfarction, revasculization of target vessel, angina found in-hospital following-up one month after-PCI. Conclusion：It is safe, feasible and effective for intracoronary combining use of anisodanmine and tirofiban to reverse the no-fellow phenomenon after-PCI of AMI.

关 键 词：心肌梗死 心肌再灌注 血管成形术 经腔 经皮冠状动脉 替罗非班 山莨菪碱 

分 类 号：R542.2[医药卫生—心血管疾病]