血栓抽吸联合替罗非班治疗急性ST段抬高性心肌梗死患者冠脉内血栓病变的疗效观察  

The Effectiveness of Clot Extraction combinded with Tirofi ban to Treat the Thrombosis in Coronary Artery of the Acute ST-segment Elevation Myocardial Infarction Patients

作　　者：傅宴[1] 张元春[1] 尹庆[1] 吴家宽[1] 戴磊[1] 

机构地区：[1]东莞市中山大学附属东华医院心内科,广东523110

出　　处：《当代医学》2009年第11期151-153,共3页Contemporary Medicine

摘　　要：目的探讨血栓抽吸联合替罗非班治疗急性ST段抬高性心肌梗死患者冠脉内血栓病变的疗效。方法42例急性ST段抬高性心肌梗死患者随机分为血栓抽吸+替罗非班组和标准经皮冠状动脉介入治疗(PCI)组,观察两组PCI术前、术后心肌梗死血栓溶解(TIMI)积分、球囊扩张次数、TIMI血流、无复流或慢血流、校正的TIMI帧计数(cTFC)、心肌灌注分级(MBG)、手术时间、术后左心室射血分数(LVEF)及住院期间出血并发症与包括死亡、再发心肌梗死、再次血运重建等的主要心血管不良事件(MACE)发生情况。结果血栓抽吸+替罗非班组与对照组相比治疗后血栓积分明显下降,球囊扩张次数减少,支架直接植入率高,最后TIMI血流改善,cTFC降低,MBG改善;左室射血分数显著高于对照组,两组住院期间的MACE发生率及出血并发症比较差异无显著意义。结论血栓抽吸与替罗非班联合治疗可改善急性ST段抬高性心肌梗死患者冠脉内血栓病变的血栓负荷、冠状动脉血流、心肌灌注和左室收缩功能,而不增加患者住院期间主要并发症的发生。Objective The objective of this research was to explore the effectiveness of clot extraction combined with Tirofiban to treat the thrombosis in coronary artery of the acute ST-segment elevation myocardial infarction patients. Method Forty-two patients with acute ST-segment elevation myocardial infarction were randomly divided into study group （clot extraction combined with Tirofiban） and control group （standard percutaneous coronary intervention）. Then we compared the thrombolysis accumulate points before and post procedure, balloon expanding times, TIMI flow grade, no reflow or slow reflow, corrected TIMI frame count （cTFC）, myocardial perfusion grade（MBG）, operation time, left ventricular ejection fraction（LVEF） post PCI, hemorrhage and major adverse cardiac events（MACE） （including death, repeat MI, repeat revascularization and so on） rate during hospitalization between two groups. Result Compared with control group, the study group reduced the thrombus accumulate points obviously, with less balloon expanding times, high success rate of direct stent planting, improved TIMI flow grade, reduced cTFC, improved MBG and high LVEF, while the difference of MACE and haemorrhage rate during hospitalization was nonsignificant. Conclusion The treatment of clot extraction combined with Tirofiban to the acute ST-segment elevation myocardial infarction patients could improve thrombus load, coronary artery flow, myocardial perfusion, left ventricular contractile function, but with no more main complications during hospitalization.

关 键 词：急性ST段抬高性心肌梗死 血栓病变 DIVER CE血栓抽吸装置 替罗非班 

分 类 号：R542.22[医药卫生—心血管疾病]