经桡动脉入径直接经皮冠状动脉介入治疗术联合替罗非班治疗急性ST段抬高型心肌梗死的临床疗效研究  

Clinical Effect of Trans- radial Primary Percutaneous Coronary Intervention Combined With Tirofiban in Patients With Acute ST- elevation Myocardial Infarction

作　　者：张丽[1] 丁世芳[1] 蒋桔泉[2] 陈志楠[2] 卢青[2] 付文波[2] 彭毅[2] 

机构地区：[1]南方医科大学研究生学院,广东省广州市510515 [2]广州军区武汉总医院心血管内科

出　　处：《中国全科医学》2016年第10期1156-1160,共5页Chinese General Practice

摘　　要：目的探讨经桡动脉入径直接经皮冠状动脉介入治疗(PCI)术联合替罗非班治疗急性ST段抬高型心肌梗死(STEMI)的临床疗效。方法选取2014年2月—2015年2月在广州军区武汉总医院成功行急诊PCI术的STEMI患者95例。根据入径方式,将其分为经股动脉入径组(n=45)和经桡动脉入径组(n=50)。比较两组的穿刺成功率、PCI术成功率,术后远端血流心肌梗死溶栓试验(TIMI)血流分级、血红蛋白下降幅度,术后1 h心电图ST段回落≥50%比例,术后1周左心室射血分数(LVEF),术后出血情况,术后入住冠心病重症监护室(CCU)时间、总住院时间,住院期间及随访6个月内主要心血管事件(MACE)发生情况,欧洲生命质量量表(EQ-5D)评价情况。结果两组穿刺成功率、PCI术成功率比较,差异无统计学意义(P>0.05)。两组术后TIMI血流分级、术后血红蛋白下降幅度、术后1 h心电图ST段回落≥50%比例、术后1周LVEF比较,差异无统计学意义(P>0.05)。两组术后TIMI轻度出血比例比较,差异无统计学意义(P>0.05);而TIMI重度出血比例比较,差异有统计学意义(P<0.05)。两组入住CCU时间、总住院时间比较,差异有统计学意义(P<0.05)。住院期间及随访6个月内,两组MACE发生率比较,差异有统计学意义(P<0.05)。EQ-5D评价中,两组行动能力、日常活动能力及焦虑/抑郁3个维度比较,差异无统计学意义(P>0.05);而自我照顾能力、疼痛/不适2个维度比较,差异有统计学意义(P<0.05)。结论经桡动脉入径直接PCI术联合替罗非班治疗STEMI的临床疗效较好,可以缩短患者入住CCU时间和总住院时间,降低术后TIMI重度出血比例,改善患者预后和生活质量,值得在临床上推广应用。Objective To evaluate the clinical efficacy of trans-radial primary percutaneous coronary intervention（ PCI） combined with tirofiban in patients with acute ST-elevation myocardial infarction（ STEMI）. Methods From February2014 to February 2015,we enrolled 95 STEMI patients who underwent successful emergency PCI in Wuhan General Hospital of Guangzhou Military Area Command. According to entry method,the patients were divided into femoral artery entry group（ n= 45） and radial artery entry group（ n = 50）. Comparison was made between the two groups in the success rate of puncture,the success rate of PCI,thrombolysis in myocardial infarction trial of distal blood flow（ TIMI） grade of blood flow after surgery,the decrease degree of hemoglobin,the proportion of patients with≥50% resolution of ST-segment involved in infarction one hour after surgery,LVEF one week after surgery,postoperative bleeding status,postoperative coronary intensive care unit（ CCU）time,total hospitalization time,major adverse cardiac event（ MACE） during hospitalization and 6-month follow-up and EQ-5D results. Results The two groups were not significantly different in the success rate of puncture and the success rate of PCI（ P 〉0. 05）. The two groups were not significantly different in TIMI grade of blood flow,the decrease degree of hemoglobin after surgery,the proportion of patients with ≥50% ST-segment resolution one hour after surgery and LVEF one week after surgery（ P 〉0. 05）. The two groups were not significantly different in the proportion of patients with mild TIMI bleeding（ P 〉0. 05） but were significantly different in the proportion of severe TIMI bleeding（ P 〈0. 05）. The two groups were significantly different in CCU time and total hospitalization time（ P 〈0. 05）. The two groups were significantly different in the incidence of MACE during hospitalization and 6-month follow up（ P 〈0. 05）. In the evaluation of EQ-5D,the two groups were not significantly different in the three

关 键 词：心肌梗死 血管成形术 气囊 冠状动脉 替罗非班 治疗结果 

分 类 号：R542.22[医药卫生—心血管疾病]