血栓抽吸联合冠状动脉内注射替罗非班对ST段抬高型患者无复流和心功能的影响  

Influences of thrombus aspiration combining intra-coronary IRA injection of tirofiban on no-reflow phenomenon and heart function in patients with STEMI

作　　者：张学志[1] 杜青 王其新 周长勇 

机构地区：[1]青岛大学医学院附属医院急诊科,266003 [2]青岛市西海岸医院麻醉科

出　　处：《中国循证心血管医学杂志》2012年第6期531-533,共3页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨替罗非班冠状动脉给药联合血栓抽吸与替罗非班静脉给药对ST段抬高型急性心肌梗死(STEMI)患者直接冠状动脉介入术(PCI)后冠脉灌注和心功能的疗效差异。方法纳入2008年2月～2012年4月STEMI患者86例(TIMI血流≤1级),随机分为实验组(n=43)和对照组(n=43)。对照组术前即开始静脉应用替罗非班,实验组则在PCI术中直接向梗死相关动脉(IRA)注射替罗非班并联合血栓抽吸。比较两组患者术后TIMI血流分级,检测术前、术后1周及6个月的血浆N-端脑钠肽前体(NT-proBNP)水平并采用超声心动图测定左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)、左室舒张末期容积指数(LVEDVI);评价心功能并观察术后6个月内两组患者心血管事件的发生率。结果①实验组术后达到TIMI血流3级比例高于对照组(92.90%vs.66.17%,P<0.05);②术后1周及术后6个月实验组和对照组比较,NT-proBNP水平均显著下降(P<0.01),LVEF显著升高(P<0.05),LVESV、LVEDV、LVEDVI显著减少(P<0.05);③术后6个月内实验组心绞痛、心力衰竭等心血管事件发生率显著降低(P<0.05)。结论 PCI术中IRA注射替罗非班联合血栓抽吸较静脉注射替罗非班可降低急诊PCI术中无复流的发生,改善血流再灌注,提高整体预后。Objective To investigate the influences of thrombus aspiration combining intra-coronary infarction-related artery （ IRA ） injection of tirofiban on no-reflow phenomenon and heart function in patients with ST-elevation myocardial infarction （ STEMI ） during percutaneous coronary intervention （ PCI ） . Methods The patients （ n =86 ） with STEMI （ TIMI ≤ 1 ） were collected from Feb. 2008 to Apr. 2012 and randomly divided into experimental group and control group （ each n =43 ） . Control group was given tirofiban before PCI and experimental group was given additionally thrombus aspiration. The changes of TIMI flow grades after PCI, level of plasma N-terminal pro-brain natriuretic peptide （ Nt-proBNP ） before PCI and one week and 6 months after PCI, and left ventricular end-diastolic volume （ LVEDV ） , left ventricular end-systolic volume （ LVESV ） , left ventricular ejection fraction （ LVEF ） and left ventricular end-diastolic volume index （ LVEDVI ） immediately after PCI and one week and 6 months after PCI were compared between two groups. The heart function was reviewed and incidence rate of major adverse cardiovascular events （ MACE ） was observed in the patients within 6 months after PCI. Results ① The patients with TIMI flow grade 3 were more in experimental group than those in control group after PCI （ 39 vs . 28, P 0.05 ） . ② The level of Nt-proBNP decreased significantly （ P 0.01 ） , LVEF increased significantly （ P 0.05 ） , and LVESV, LVEDV and LVEDVI decreased significantly （ P 0.05 ） in experimental group compared with control group one week and 6 months after PCI. ③ The incidence rate of MACE including angina and heart failure decreased significantly （ P 0.05 ） in experimental group within 6 months after PCI. Conclusion Thrombus aspiration combining intra-coronary IRA injection of tirofiban can reduce the incidence of no-reflow phenomenon during emergency PCI, relieve flow reperfusion in infarction area, improve left ventricular fu

关 键 词：急性心肌梗死 血栓抽吸 替罗非班 冠状动脉介入术 无复流 

分 类 号：R542.22[医药卫生—心血管疾病]