血栓抽吸导管联合替罗非班对急性ST段抬高型心肌梗死恢复心肌“再灌注”的近期临床疗效观察  

Short-term Effect of Thrombus Aspiration Catheters Combining Tirofiban Medication for Myocardial Tissue Reperfusion Recovery in Patients With Acute ST-elevation Myocardial Infarction

作　　者：简立国[1] 刘士超[1] 王鹏飞[1] 丁同斌[1] 赵江涛[1] 程栋[1] 任新伟[1] 

机构地区：[1]郑州大学第二附属医院心内科,河南省郑州市450014

出　　处：《中国循环杂志》2014年第7期501-504,共4页Chinese Circulation Journal

摘　　要：目的：评价血栓抽吸导管联合替罗非班开通急性ST段抬高型心肌梗死（STEMI）患者梗死相关动脉对恢复心肌“再灌注”的近期临床疗效。方法：选择2011-05至2013-05在我院急诊行经皮冠状动脉介入治疗（PCI）的STEMI患者105例，其中男性73例，女性32例，平均年龄58.39±10.37（35-83）岁。将患者随机分为两组，应用血栓抽吸导管联合经冠状动脉内注射替罗非班的53例患者为A组，单独使用替罗非班而行PCI的52例患者为B组，比较两组间的临床基础资料特征、心肌组织灌注水平、术后住院期间和随访6个月的主要心血管事件、术后6个月超声心动图检查测定的心功能。结果：两组间的临床基础资料差异无统计学意义。A组术后心肌梗死溶栓治疗临床试验（TIMI）3级血流发生率显著高于B组（92.45%vs 55.77%，P〈0.001），A组TIMI2级、TIMI0-1级的发生率显著低于B组（7.55%vs 26.92%， P=0.008；0 vs 17.31%，P=0.002）；A组校正TIMI帧数低于B组[（27.26±5.50）帧vs（38.98±5.42）帧，P〈0.001]；术后6个月A组超声心动图检查测定的左心室射血分数大于B组[（0.55±0.06）vs（0.47±0.06），P〈0.001]，左心室舒张末期内径小于B组[（50.77±5.45）mm vs（54.76±5.34）mm，P〈0.001]；术后住院期间和随访6个月A组心绞痛和靶血管再次血运重建率低于B组（16.98%vs 40.38%，P=0.008；9.43%vs 17.31%，P=0.008），两组比较差异均有统计学意义。术后住院期间和随访6个月A组的心肌梗死发生率、急性心力衰竭发生率、心原性死亡发生率、非靶血管再次血运重建率均低于B组，但差异均无统计学意义（P〉0.05）。结论：在急诊PCI中血栓抽吸导管联合应用替罗非班可以显著改善STEMI患者心肌再灌注和PCI术后近期的心功能，降低无复流的发生率，不增加主要不良心血管事件发生率。Objective： To evaluate the short-term effect of thrombus aspiration catheters combining tiroifban medication for myocardial tissue reperfusion recovery in patients with acute ST-elevation myocardial infarction （STEMI）. Methods： A total of 105 STEMI patients with percutaneous coronary intervention （PCI） in our hospital from 2011-05 to 2013-05 were studied, there were 73 male and 32 female with the mean age of （58.39 ± 10.37） years. The patients were randomly divided into 2 groups, Group A, the patients received thrombus aspiration catheters with intravenous tiroifban, n=53 and Group B, the patients received tiroifban and PCI, n=52. The basic clinical features, myocardial tissue perfusion level, major adverse cardiovascular events （MACE） at post operative and in-hospital period were recorded, the cardiac function was examined by echocardiography at 6 months after PCI in both groups. 〈br〉 Results： The basic clinical features were similar between 2 groups. The thrombolysis in myocardial infarction trial （TIMI） 3 lfow rate was higher in Group A than that in Group B （92.45% vs 55.77%）, P=0.000. TIMI 2 and TIMI 0-1 lfow rates were lower in Group A than that in Group B （7.55%vs 26.92%）, P=0.008 and （0%vs 17.31%）, P=0.002. The adjusted TIMI frame was lower in Group A （27.26±5.50） vs （38.98±5.42）, P〈0.001. The echocardiography at 6 months after PCI indicated that Group A had higher LVEF than that in Group B （0.55±0.06） vs （0.47±0.06）, P〈0.001;lower left ventricular end diastolic diameter （50.77±5.45） vs （54.76±5.34）, P〈0.001;less angina and target vessel revascularization （16.98%vs 40.38%）, P=0.008 and （9.43%vs 17.31%）, P=0.008. The incidence of MI, acute heart failure, cardiac death and non-target vessel revascularization were similar between 2 groups, P〉0.05. Conclusion：Thrombus aspiration catheters combining tiroifban medication may obviously improve the myocardial tissue reperfusion and the short-term cardiac function in STEMI

关 键 词：心肌梗死 血栓抽吸导管 替罗非班 心肌组织再灌注 

分 类 号：R541[医药卫生—心血管疾病]