经微导管注射不同药物对急诊经皮冠状动脉介入治疗术中无复流现象的疗效研究  

Effect of different drugs injected intra-microcatheter on no-reflow phenomenon during percutaneous coronary interventions for acute myocardial infarction

作　　者：赵季红[1] 孙婧[1] 赵鹏[1] 周欣[1] 储毓舜[1] 毕莹[1] 姜铁民[1] 

机构地区：[1]武警后勤学院附属医院心脏医院,天津300162

出　　处：《生物医学工程与临床》2014年第4期369-373,共5页Biomedical Engineering and Clinical Medicine

基　　金：武警后勤学院2012年学院级科研课题(WHM201218)

摘　　要：目的探讨急诊经皮冠状动脉介入治疗术（PCI）中出现无复流现象后,经微导管向远端血管床注射不同药物的临床效果。方法选择急诊PCI术中无复流现象的患者66例,其中男性44例,女性22例;年龄46~79岁,平均年龄60.5岁。随机平均分为A组（维拉帕米）、B组（替罗非班）、C组（硝酸甘油）。分别记录3组PCI手术结束时血流达到心肌梗死溶栓（TIMI）-3级和心肌组织灌注分级（TMPG）-3级的例数、出现无复流到首次开始注射药物的时间、血流恢复TIMI-3级的时间、心肌组织灌注恢复TMPG-3级的时间、PCI手术时间、X射线暴露时间和术后1周左心室射血分数（LVEF）,进行统计分析。结果 A组与B组血流达到TIMI-3级例数分别为16例、13例,差异无统计学意义（P〉0.05）,但二者明显高于C组8例（P〈0.05）;A组TMPG-3级例数为16例,高于B组和C组（P〈0.05）;A组出现无复流到恢复TIMI-3级和心肌组织灌注恢复TMPG-3级的时间分别为（6.6±2.5）min、（6.9±3.1）min,显著小于B组[（8.9±3.1）min、（13.4±4.5）min]和C组[（11.6±2.9）min、（17.1±4.2）min]（P〈0.05）;A组与B组PCI手术时间和X射线暴露时间差异无统计学意义（P〉0.05）,但二者明显短于C组（P〈0.05）;A组与B组术后1周LVEF相比差异无统计学意义（49.3%±7.7%vs 43.2%±8.1%,P〉0.05）,但二者明显优于C组（37.1%±6.7%,P〈0.05）。结论与替罗非班和硝酸甘油相比较,经微导管向远端血管床注射维拉帕米,可以即刻提高靶血管血流灌注和心肌组织灌注,缩短手术时间,改善心脏功能,是临床实践中改善无复流现象的有效治疗方法。Objective To investigate the clinical effect of different drugs injected intra-micro catheter on no-reflow phenomenon during percutaneous coronary interventions（PCI） for acute myocardial infarction（AMI）. Methods A total of 66 patients with noreflow phenomenon during emergency PCI, which included 44 males and 22 females, aged 46- 79 years old with mean age of60.5. All of them were randomly divided into 3 groups, group A（verapamil, n = 22）, group B（tirofiban, n = 22） and group C（nitroglycerin, n = 22）. The cases of thrombolysis in myocardial infarction- 3（TIMI-3） flow grade and TIMI myocardial perfusion-3（TMPG-3） grade at the endpoint of PCI, the time from no-reflow to the first drug injection, the time from no-reflow to restored TIMI-3 blood flow and TMPG-3 perfusion, the time of PCI and X-ray exposure and left ventricular ejection fraction（LVEF） after1-week were statistical analyzed. Results There was no significant difference in cases of TIMI-3 blood flow at the endpoint of PCI between group A（16 cases） and group B（13 cases, P ＆gt; 0.05）,but the statistical difference in 2 groups was significantly higher than that in group C（8 cases, P ＆lt; 0.05）. The amount of TMPG-3 perfusion in group A（16 cases） was significantly higher than that in group B（10 cases） and group C（6 cases, P ＆lt; 0.05）. The time from no-reflow to restored TIMI-3 blood flow and TMPG-3 perfusion in group A[（6.6 ± 2.5） minutes and（6.9 ± 3.1） minutes] were significantly less than those in group B[（8.9 ± 3.1） minutes and（13.4 ±4.5） minutes] and group C[（11.6 ± 2.9） minutes and（17.1 ± 4.2） minutes, P ＆lt; 0.05]. The time of PCI and X-ray exposure in group A and group B was no significantly difference, but both of them were shorter than those in group C（P ＆lt; 0.05）. The LVEF after 1- week in group A and group B was no significant difference（49.3 % ± 7.7 % vs 43.2 % ± 8.1 %, P ＆gt; 0.05）, both of them were better than that in group C（49.3 % ±

关 键 词：经皮冠状动脉介入治疗 急性心肌梗死 无复流现象 微导管注射 维拉帕米 替罗非班 硝酸甘油 

分 类 号：R542.22[医药卫生—心血管疾病] R45[医药卫生—内科学]