血栓抽吸联合冠状动脉内注射替罗非班对急性ST段抬高性心肌梗死患者的疗效观察  

Thrombus aspiration cathter plus intracoronary injections of tirofiban in patients with acute ST-elevation myocardial infarction during primary percutaneous coronary intervention

作　　者：张红雨[1] 王佩显[2] 曹艳君[1] 吴志国[1] 王立强[1] 仇宝华[1] 张霞[1] 梅莲莲[1] 王淑静[1] 

机构地区：[1]天津医科大学宝坻临床学院心内科,天津301800 [2]天津医科大学总医院心内科

出　　处：《临床心血管病杂志》2012年第10期758-761,共4页Journal of Clinical Cardiology

摘　　要：目的:评价血栓抽吸联合冠状动脉内注射替罗非班,在急性ST段抬高性心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)中的疗效。方法:回顾性分析急性STEMI行直接PCI术患者124例,术中使用血栓抽吸联合冠状动脉内推注替罗非班的56例患者做为观察组,以同期行常规直接PCI术的STEMI患者68例做为对照组。评估PCI术后即刻心肌梗死溶栓试验(TIMI)血流分级、TIMI心肌组织灌注分级(TMPG)及矫正的TIMI帧数(cTFC)、PCI术中无复流的发生率、直接支架置入率、PCI术后90min完全ST段回落率、肌酸激酶同工酶(CK-MB)和肌钙蛋白T(TnT)峰值、PCI术后7d左心室射血分数(LVEF)、住院期间和PCI术后3个月内主要心脏不良事件(MACE)发生率。结果:与对照组比较,观察组PCI术后即刻TIMI 3级及TMPG 3级血流比例更高(分别为94.6%∶80.9%,91.1%∶73.5%,P<0.05);cTFC帧数更少[(44.1±16.7)帧∶(57.1±23.1)帧,P<0.01];无复流发生率低(5.4%∶19.1%,P<0.05);直接支架置入率高(21.4%∶8.8%,P<0.05);PCI术后90min完全ST段回落率高(85.7%∶67.6%,P<0.05);CK-MB和TnT峰值低[分别为(172.4±45.6)U/L∶(201.7±39.5)U/L,(5.46±1.82)ng/L∶(6.59±1.97)ng/L,P<0.01];PCI术后7dLVEF高[(56.3±7.8)%∶(52.7±6.8)%,P<0.01]。观察组住院期间MACE少于对照组(14.3%∶26.5%),但差异无统计学意义,而PCI术后3个月内MACE亦少于对照组(26.8%∶44.1%),且差异有统计学意义(P<0.05)。结论:血栓抽吸联合冠状动脉内注射替罗非班可以增加急性STEMI患者直接PCI术中的冠状动脉血流和心肌组织灌注,减少无复流发生,减少心肌坏死,改善心功能和预后。Objective：To investigate the clinical effect of thrombus aspiration plus intracoronary injections of tirofiban in patients with acute ST-elevation myocardial infarction （STEMI） during percutaneous coronary inter- vention （PCI）. Method：We reviewed 124 acute STEMI patients in our hospital who were veceoved primary PCI, in which Fifty-six patients treated with thrombus aspiration cathter plus intracoronary injections of tirofiban were devided as observe group, and 68 patients treated routinely were devideds control group. Thrombolysis in myocar- dial infarction （TIMI） flow grade, TIMI myocardial perfusion grade （TMPG）, corrected TIMI frame count （cTFC）, the rate of occuring no-reflow phenomenon and directly implanting stents, completed ST-segment eleva- tion resolution at 90 minutes after PCI, the peak of creatine kinase-MB （CK-MB） and troponin T （TnT）, left ven- tricle ejection fraction （LVEF） in one week after PCI and major adverse cardiovascular events （MACE） in hospital and 3 months after PCI were all compared between the 2 groups. Result：Compared with the control group. There were significantly better in TIMI 3 and TMPG 3 flow degree （94.6% vs 80.9%, 91.1% vs 73.5~/00, P〈0.05）, higher in cTFC [-（44.1-t-16.7） vs （57.14-23.1）, P〈0.01], lower in the rate of no-reflow phenomenon （5.4~ vs 19.1%, P〈0.05） and higher in the rate of directly implanting stents （21.4% vs 8.8%, P〈0.05） in the observe group. The complete ST-segment resolution at 90 minutes after PCI was significantly higher in the observe group than the control group （85.7% vs 67.6%, P〈0.05）. The peak of CK-MB and TnT were significantly lower in

关 键 词：心肌梗死 血管成形术 经腔 经皮冠状动脉 血栓抽吸 替罗非班 

分 类 号：R542.2[医药卫生—心血管疾病]