硝普钠联合欣维宁对PCI术中无复流的疗效观察  

Clinical observation of intracoronary nitroprusside and tirofiban for the prevention of no-reflow phenomenon following percutaneous coronary intervention

作　　者：徐中林[1] 赵义发[1] 吴兰兰[1] 

机构地区：[1]重庆市第九人民医院心内科,重庆400700

出　　处：《泸州医学院学报》2014年第3期271-275,共5页Journal of Luzhou Medical College

摘　　要：目的:观察冠状动脉内注射硝普钠和欣维宁对经皮冠状动脉介入治疗(PCI)术中无复流的治疗效果。方法:将PCI术中发生无复流现象的患者63例随机分为硝普钠与欣维宁联合用药组(A组,n=32)和欣维宁组(B组,n=31)。2组患者使用相同的PCI手术方法,对术中判断为无复流的患者,A组给予冠状动脉内注射硝普钠和欣维宁,B组注射欣维宁。观察2组患者用药后即刻及用药后5 min的造影图像,分析TIMI血流分级和校正的TIMI帧计数(CTFC),同时观察术中血压变化,术后1周氨基末端B型利钠肽(NT-proBNP)、左室射血分数(LVEF)及术后半年主要心血管事件(MACE)发生率和再次住院率。结果:A组患者TIMI 3级获得率、CTFC值均优于B组(P<0.05),术后1周A组患者NT-proBNP低于B组而LVEF明显高于B组(P<0.05),术后6个月主要心血管事件发生率差异无统计学意义(P>0.05),但A组患者再次住院率明显低于B组(P<0.05)。结论:冠状动脉内注射硝普钠联合欣维宁能明显改善PCI术中的无复流现象,并可能部分改善患者的远期预后。Objective： To evaluate the effect of intracoronary nitroprusside and tirofiban on the prevention of no-reflow phenomenon following percutaneous coronary intervention. Methods： Sixty-three patients with no- reflow phenomenon following PCI were randomly divided into nitroprusside combined tirofiban group （group A, n= 32） and tirofiban group （group B, n=31）. The angiographic results including thrombolyses in myocardial infarction （TIMI） and corrected TIMI frame count （CTFC）,the blood pressure during PCI, NT-proBNP and left ventricular ejection fraction （LVEF） after PCI for 1 week, incidence of major adverse cardiovascular events （MACE） and the hospitalization rate due to cardiovascular events within 6 months were observed in both groups. Results： The incidence of final TIMI-3 flow was much higher and final corrected TIMI frame count （CTFC） decreased significantly in group A than in group B （P 〈 0.05）.Compared with group B, the blood pressure did not decrease significantly in group A （P 〉 0.05）. NT-proBNP was lower and LVEF was higher in group A than in group B after PCI for 1 week （P 〈 0.05）. There was no significant difference in MACE between two groups in 6 months follow-up （P 〉 0.05）. The hospitalization rate due to cardiovascular events （AMI, heart failure, arrhythmia, et al.） in group A was significantly lower than that in group B（P 〈 0.05）. Conclusion： Intracoronary nitroprusside combined tirofiban can prevent no-reflow phenomenon effectively during PCI and lead to better prognosis.

关 键 词：硝普钠 欣维宁 PCI 无复流 

分 类 号：R543.3[医药卫生—心血管疾病]