经靶向灌注导管在冠状动脉靶病变远段给予替罗非班对急性冠状动脉综合征患者心肌灌注的影响  

Effect of intracoronary administration of tirofiban through perfusion micro-catheter on myocardial perfusion in patients with acute coronary syndrome undergoing percutaneous coronary intervention

作　　者：孙宇珺 周雯[1] 丁嵩[1] 杨帆[1] 孔令璁 高灵辰 李臻[1] 赵航[1] 龚兴荣[1] 葛恒[1] 卜军[1] 何奔[1] 

机构地区：[1]上海交通大学医学院附属仁济医院心内科,上海200127

出　　处：《中国介入心脏病学杂志》2015年第1期5-10,共6页Chinese Journal of Interventional Cardiology

基　　金：上海市领军人才和上海市医学领军人才项目(LJ10007);上海申康新兴前沿技术项目(SHDC12013119);上海市曙光人才计划(12SG22)

摘　　要：目的比较经靶向灌注导管和经指引导管冠状动脉内给予血小板糖蛋白Ⅱb/Ⅲa抑制剂替罗非班,对急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后的影响。方法回顾性分析113例在PCI术后发生TIMI血流分级≤Ⅱ级并由术者决定补救性冠状动脉内注射替罗非班的ACS患者。其中经靶向灌注导管给药组55例,经指引导管给药组58例。比较两组患者给药后心外膜冠状动脉灌注及心肌组织灌注水平、术后院内主要不良心脑血管事件(MACCE)及出血事件发生率。结果两组患者一般临床资料差异无统计学意义(均P>0.05)。给药后,经靶向灌注导管给药组心肌灌注水平显著优于经指引导管给药组(P=0.0172);住院期间,两组患者院内MACCE和出血事件发生率相当(P=0.471、P=0.901)。结论与经指引导管冠状动脉内给予替罗非班相比,经靶向灌注导管在靶病变远段给药显著改善ACS患者心肌组织灌注水平,两者院内MACCE及出血事件发生率相当。Objective To compare the effects of two approaches of intra-coronary administration of tirofiban（ through perfusion micro-catheter verses through guiding catheter） on myocardial perfusion and inhospital clinical outcomes in patients with acute coronary syndrome（ ACS） undergoing percutaneous coronary intervention（ PCI）. Methods One hundred and thirteen patients with ACS treated by PCI with TIMI flow≤2 grade in target vessel were retrospectively screened. Among them,55 patients received intracoronary administration of tirofiban through perfusion micro-catheter（ observation group）. Baseline features,epicardial and myocardial perfusion, and in-hospital major adverse cardiac and cerebrovascular events（ MACCE） and bleeding rate were compared with those receiving intracoronary injection of tirofiban through guiding catheter（ control group,n = 58）. Results Baseline features were comparable between the two groups（ all P〉0. 05）. Compared with control group,patients in observation group obtained more favorable myocardial perfusion（ P = 0. 0172）. In-hospital MACCE rate and bleeding events were similar between the two groups（ P = 0. 471 and P = 0. 901,respectively）. Conclusions Intracoronary delivery of tirofiban through perfusion micro-catheter improved myocardial perfusion in ACS patients compared with intracoronary injection of tirofiban through guiding catheter. Both groups had similar in-hospital MACCE rate and bleeding events. Large-scale,prospective,randomized clinical study is mandatory to prove current results.

关 键 词：急性冠状动脉综合征 经皮冠状动脉介入治疗 血小板糖蛋白Ⅱb/Ⅲa抑制剂 心肌灌注 

分 类 号：R541.4[医药卫生—心血管疾病]