血栓抽吸导管冠脉闭塞段注入替罗非班治疗急性心肌梗死的疗效分析  

The effect of tirofiban injected in thrombus aspiration catheter coronary artery occlusion for patients with acute myocardial infarction

作　　者：何小萍[1] 苏少辉[1] 叶健烽[1] 

机构地区：[1]广东省东莞市人民医院心内科,523000

出　　处：《中国现代医药杂志》2015年第6期27-30,共4页Modern Medicine Journal of China

基　　金：广东省医学科研基金立项课题(编号:B2012383)

摘　　要：目的分析研究通过血栓抽吸导管直接在冠状动脉闭塞段内注入替罗非班对急性心肌梗死患者的无复流、慢血流现象的影响及其改善心肌灌注的疗效。方法我院近2年收住的163例急性ST段抬高型心肌梗死患者,均接受直接PCI术,冠状动脉造影显示血栓负荷重,均对其使用血栓抽吸导管行反复血栓抽吸,然后把患者随机分为A、B两组。A组通过血栓抽吸导管在冠状动脉口处注射替罗非班;B组通过血栓抽吸导管直接在冠状动脉闭塞段内注入替罗非班。对比两组冠状动脉注射替罗非班前后无复流发生率、即刻靶血管TIMI血流分级的变化及出院后1、3、6月左室射血分数(LVEF)和左心室舒张末期内径(LVEDD)、心血管事件及出血并发症。结果两组患者出血并发症发生率间差异无统计学意义(P>0.05)。以B组无复流发生率最低、TIMI分析Ⅲ级所占比例最高(P<0.01),且各时间段不良心脏事件发生率最低;A组和B组术后1个月LVEF、LVEDD无明显差异(P>0.05),而术后3个月和术后6个月则存在明显差异(P<0.05或0.01),A组与B组在各时间段的出血及血小板减少率方面无统计学差异(P>0.05)。结论直接PCI术患者使用替罗非班在冠脉闭塞段直接注入可有效降低PCI术后患者无复流现象的发生,并不增加出血风险,能有效改善急性心肌梗死患者冠状动脉血流及心肌组织灌注,从而改善预后。Objective To analyze the effect on no-reflow and slow flow phenomenon , the improvement of myocardial perfusion of tirofiban dirtectly injected in thrombus aspiration catheter coronary artery occlusion for patient with acute myocardial infarction. Methods 163 patients with acute ST segment elevation myocardial infarction patients accepted PCI during the lastest 2 years in our hospital, coronary angiography showed high burden thrombus, thrombus aspiration catheter was taken re-peatedly for thrombus aspiration, and then were randomly divided into two groups （group A and group B）. Group A accepted tirofiban injection through thrombus aspiration combined with thrombus aspiration catheter , group B accepted tirofiban injection at thrombus aspiration combined with thrombus aspiration catheter directly in the coronary artery occlusion. Compared the no-re-flow occurrence, the immediate target artery TIMI flow grade changes and left ventricular ejection fraction （LVEF） and left ven-tricular diastolic end diastolic diameter （LVEDD） after 1, 3, 6 months and cardiovascular events and bleeding complications of the two groups before or after the coronary artery tirofiban injection. Results There was no significant difference in the inci-dence of bleeding complications between the two groups （P〉0.05）. The no-reflow rate was the lowest and TIMI analysis grade Ⅲaccounted for the highest proportion （P〈0.01）, and the adverse cardiac event rate was the lowest in group B; LVEF and LVEDD had no significant difference 1 month after operation in group A and group B （P〉0.05）, but that had significant differ-ence 3 months and 6 months after operation （P〈0.05 or 0.01）. Conclusion Tirofiban injection in coronary artery occlusion can effectively reduce the incidence of no-reflow phenomenon after PCI, without increasing the risk of bleeding, effectively im-prove the coronary blood flow and myocardial tissue perfusion of acute myocardial infarction patients and improve the prognosis.

关 键 词：血栓抽吸 无复流 冠状动脉闭塞段 替罗非班 

分 类 号：R542.22[医药卫生—心血管疾病]