直接经皮冠状动脉介入治疗中血栓抽吸联合梗死相关动脉内应用替罗非班的有效性和安全性  

Efficiency and safety of thrombus aspiration plus intra-infarct-related artery administration of tirofiban during primary angioplasty

作　　者：李世英[1] 颜红兵[1] 王健[1] 宋莉[1] 吴铮[1] 迟云鹏[1] 郑斌[1] 赵汉军[1] 李庆祥[1] 张晓江[1] 李文铮[1] 刘臣[1] 

机构地区：[1]首都医科大学附属北京安贞医院二十八病区,100029

出　　处：《中华心血管病杂志》2010年第10期880-885,共6页Chinese Journal of Cardiology

基　　金：基金项目：北京市自然科学基金（7082030）;首都医学发展科研基金（200%2076）

摘　　要：目的 评价在ST段抬高型心肌梗死（STEMI）患者直接经皮冠状动脉介入治疗（PCI）中联合应用血栓抽吸和经抽吸导管梗死相关动脉内注射替罗非班的有效性和安全性.方法 试验分为2组：血栓抽吸＋替罗非班组：2007年1月至2009年3月108例STEMI患者进行血栓抽吸后经抽吸导管梗死相关动脉内应用替罗非班500μg,置入支架后静脉滴注12 h替罗非班0.1μg·kg-1·min-1 单纯血栓抽吸组：2005年1月至2006年12月108例STEMI患者血栓抽吸后置人支架.主要终点：PCI术后即刻心肌梗死溶栓试验（TIMI）血流、术后90 min完全ST段回落率、肌酸激酶同工酶（CK-MB）和肌钙蛋白I峰值.二级终点：住院期间和9个月随访左心室射血分数、主要不良心血管事件（靶血管重建、再次心肌梗死、死亡）和出血事件.结果 两组患者基线特征差异无统计学意义.血栓抽吸＋替罗非班组与单纯血栓抽吸组TIMI 3级血流率分别为97.22%和87.04%（P=0.011）,完全ST段回落率分别是66.67%和50.91%（P=0.047）,CK-MB峰值分别是83.9（68.9～310.5）U/L和126.1（74.7～356.7）U/L（P=0.034）,肌钙蛋白Ⅰ峰值分别是42.7（14.7～113.9）μg/L和72.5（59.8～135.3）μg/L（P=0.029）.住院期间,血栓抽吸＋替罗非班组和单纯血栓抽吸组的左心室射血分数分别为（45.7±10.8）%和（42.9±9.9）%（P=0.049）.9个月随访显示,血栓抽吸＋替罗非班组主要不良心血管事件有降低趋势（log rank χ2=2.865,P=0.09）.两组间出血事件差异无统计学意义.结论 直接PCI中联合应用血栓抽吸和经抽吸导管在梗死相关动脉内超选择应用替罗非班可以改善心肌灌注.Objective To investigate whether thrombus aspiration plus intra-infarct-related artery bolus administration of tirofiban via the aspiration catheter is superior to thrombus aspiration alone in improving myocardial perfusion in patients with ST-elevation myocardial infarction （STEMI） undergoing primary angioplasty. Methods In this single center retrospective study, 108 patients with STEMI who underwent angioplasty after thrombus aspiration plus intra-infarction related artery 500 μg tirofiban administration, with subsequent 12-hour intravenous infusion of 0. 1 pg · kg-1 · min-1 after angioplasty （thrombus aspiration ＋ tirofiban group） and 108 matched control patients with STEMI who underwent angioplasty after thrombus aspiration （thrombus aspirartion group ）. The primary end points included thrombolysis in myocardial infarction （T1MI） flow immediately after angioplasty, complete ST-segnent elevation resolution （ 〉70% ） at 90 minutes after angioplasty and the peak of creatine kinase-MB （CK-MB）and troponin I （TnI）. The secondary end points were the left ventricular ejection fraction （LVEF） in the hospital and at 9 months follow-up as well as major adverse cardiac events （ MACE： cardiac death, target vessel revascularization, re-infarction ） at 9 months and any bleeding events. Results Baseline characteristics of the two groups were well-balanced. The TIMI 3 flow rate （97.22% vs. 87. 04%, P =0. 011 ） and the complete ST-segment resolution rate （66. 67% vs. 50. 91% ,χ2 =6. 129,P = 0. 047）were significantly higher in the thrombus aspiration ＋ tirofiban group than in the thrombus aspiration group. The peak of CK-MB （83.9 U/L vs. 126. 1 U/L, P = 0. 034） and TnI （42. 7 ng/ml vs. 72.5 ng/ml, P =0. 029） were significantly lower in the thrombus aspiraton ＋ tirofiban group than in the thrombus aspiration group. LVEF in the hospital favored thrombus aspiraton ＋ tirofiban the group （45.7% ＋ 10. 8%, 42. 9%±9.9%, t = 1.99, P =0. 049）. There was a tendency

关 键 词：心肌梗死 血管成形术 经腔 经皮冠状动脉 替罗非班 

分 类 号：R686[医药卫生—骨科学]