血栓抽吸导管内注射硝普钠对急性心肌梗死介入治疗中无复流现象的作用  

No-reflow phenomenon in primary PCI of AMI:effect of nitroprusside injection from thrombus aspiration catheter

作　　者：孙家安[1] 汝磊生[1] 李俊峡[1] 彭育红[1] 杨莉[1] 梅静[1] 郭晓萍[1] 

机构地区：[1]解放军白求恩国际和平医院心内科,河北石家庄050082

出　　处：《临床荟萃》2010年第7期567-569,共3页Clinical Focus

摘　　要：目的评价经ZEEK血栓抽吸导管注射硝普钠对急性心肌梗死(AMI)介入治疗中梗死相关动脉(IRA)无复流现象的影响。方法选择白求恩国际和平医院AMI急诊经皮冠状动脉介入治疗(PCI)后再通的IRA存在无复流现象者43例。所有病例均给予血栓抽吸导管抽吸血栓,其中21例患者入选硝普钠组,经ZEEK血栓抽吸导管抽吸后超选择性IRA内注射硝普钠100μg,2秒内"弹丸式"快速注射完毕,22例患者梗死相关冠状动脉内注射生理盐水5 ml,10分钟后复查冠状动脉造影,评定冠状动脉血流心肌梗死溶栓试验(TIMI)分级及校正TIMI帧数(cTFC)。结果两组均可明显改善急诊PCI后的无复流现象,硝普钠组所有患者IRA血流恢复TIMI 3级,cTFC帧数由用药前的(83.7±7.0)帧降至(26.5±5.8)帧,而对照组从(84.5±6.5)帧降至(39.8±10.7)帧,两组差异有统计学意义(P<0.05)。结论 ZEEK血栓抽吸导管联合超选择性IRA内快速注射硝普钠100μg能更有效地改善AMI急诊PCI中无复流现象,值得临床进一步研究。Objective To evaluate the effect of thrombus aspiration combined with superselective intraeoronary injection of nitroprusside in infarction-related artery（IRA） on no reflow phenomenon of primary percutaneous coronary artery intervention（PCI）. Methods Forty-three acute myocardial infarction patients with no-reflow phenomenon after primary PCI were selected. Superseleetive intracoronary IRA injection of nitroprusside from ZEEK thrombus aspiration catheters was used in 21 cases,and injection of saline water was used in 22 cases. Coronary angiography was rechecked 10 minutes after injection,TIMI and CTFC of IRA blood flow were assessed. Results No reflow phenomenon relived in both groups. All cases in nitroprusside group restored TIMI 3 blood flow. CTFCs of IRA were decreased from （83.7± 7.0） frame to （ 26.5 ± 5.8） frame （ P 〈0.01 ） after superselective intracoronary injection of nitroprusside in superselective group, while those in control group reduced from （84.5 ±6.45 ） frame to （39.8±10.7） frame. IRA TIMI and CTFC difference between two groups had statistic significance （ P〈0.01 ）. Conclusion Superseclective injection of 100μg nitroprusside in IRA combined with thrombus aspiration can effectively improve no-reflow phenomenon in primary PCI of AMI,this method is worth additional clinic study.

关 键 词：心肌梗死 硝普钠 经皮冠状动脉介入治疗 

分 类 号：R542.2[医药卫生—心血管疾病]