经微导管注射替罗非班联合硝普钠或硝酸甘油对择期经皮冠状动脉介入治疗中无复流的作用  

Effects of tirofiban combined with nitroprusside or nitroglycerin injection through microcatheter on no-reflow phenomenon during elective percutaneous coronary intervention

作　　者：黄自明[1] 郭观华[1] 彭俊[1] 

机构地区：[1]湛江中心人民医院心内科,广东湛江524037

出　　处：《岭南心血管病杂志》2015年第4期466-469,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨经微导管注射替罗非班联合硝普钠或硝酸甘油对择期经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗中无复流(no-reflow,NR)的即刻疗效。方法入选2012年3月至2014年5月在湛江中心人民医院行择期PCI治疗中发生无复流的患者61例,随机数字表法随机分为替罗非班联合硝普钠组31例,替罗非班联合硝酸甘油组30例。评价给药前、后冠状动脉血流心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)分级及校正TIMI帧数(corrected TIMI frame count,CTFC)并随访术后一周时的左心室射血分数。结果两组基线资料一致。给药10 min后,替罗非班联合硝普钠组有26例(83.9%)达到TIMI血流3级,校正CTFC为(32.3±11.9)帧,而替罗非班联合硝酸甘油组18例(60%)达到TIMI血流3级,CTFC为(40.1±14.5)帧,两组比较差异有统计学意义(P=0.04;P=0.02)。随访一周时,两组左心室射血分数比较,差异无统计学意义(52.9%±7.7%vs.51.6%±9.7%,P=0.56)。结论经微导管注射替罗非班联合硝普钠对择期PCI治疗中无复流的即刻血流改善效果优于替罗非班联合硝酸甘油。Objectives To investigate the instant effects of tirofiban combined with nitroprusside or nitroglycerin injection through microcatheter on no-reflow（NR） phenomenon during elective percutaneous coronary intervention（PCI）.Methods From March 2012 to May 2014, 61 patients who received elective PCI in Central People ＇s Hospital of Zhanjiang with NR phenomenon were randomly divided into tirofiban combined with nitroprusside group（n =31） and tirofiban combined with nitroglycerin group（n =30）. Thrombolysis in myocardial infarction（TIMI） grade and corrected TIMI frame count（CTFC） of target coronary artery were detected before and 10 minutes after administration. Left ventricular ejection fraction（LVEF） at one-week follow-up was assessed. Results The baseline clinical data was comparable in the two groups. At 10 minutes after drug injection, there were 26（83.9%） patients with TIMI grade 3 in tirofiban combined with nitroprusside group, and 18（60%） patients in tirofiban combined with nitroglycerin group. The CTFC was 32.3 ±11.9 in tirofiban combined with nitroprusside group and 40.1 ±14.5 in tirofiban combined with nitroglycerin group. The differences in TIMI and CTFC between the two groups were significant（P =0.04;P =0.02,respectively）. LVEF at one-week follow-up was 52.9% ±7.7% and 51.6% ±9.7% in the two groups, respectively, and the difference did not reach statistical significance（P=0.56）. Conclusions Instant effect of tirofiban combined with nitroprusside injection through microcatheter on improvement of NR phenomenon during elective PCI is better than that of tirofiban combined with nitroglycerin.

关 键 词：冠状动脉疾病 无复流现象 血管成形术 经腔 经皮冠状动脉 硝普钠 硝酸甘油 替罗非班 

分 类 号：R541.4[医药卫生—心血管疾病]