自制微导管冠状动脉内应用硝普钠及替罗非班对经皮冠状动脉介入术中无复流现象的影响  

Effect of intra-coronary application of nitroprusside and tirofiban through home-made microcatheter on no-reflow phenomenon during percutaneous coronary intervention

作　　者：刘辉[1] 张少利[1] 张永春[1] 张俊彪[1] 霍建华[2] 

机构地区：[1]新乡医学院第一附属医院心血管内二科,453100 [2]西安交通大学第一附属医院心血管内科,710000

出　　处：《中国医药》2016年第10期1434-1438,共5页China Medicine

基　　金：河南省医学科技攻关计划（2011020092）

摘　　要：目的探讨自制微导管冠状动脉内应用硝普钠及替罗非班对经皮冠状动脉介入（PCI）术中无复流现象的影响。方法选取2014年12月至2015年12月在西安交通大学第一附属医院行PCI治疗后发生无复流现象的急性冠状动脉综合征（ACS）患者21例为观察组，选取2014年7月至2015年12月在新乡医学院第一附属医院行PCI术后发生无复流现象的ACS患者19例为对照组。PCI术中出现无复流现象时，对照组通过指引导管经冠状动脉相继给予硝酸甘油及替罗非班；观察组用自制微导管经冠状动脉注射硝普钠和替罗非班。比较2组用药后1、10min的TIMI血流分级和校正的TIMI帧计数（CTFC）值；比较2组患者用药前和用药10min后冠状动脉内有创血压变化。结果用药后1、10min观察组恢复TIMI血流分级3级比例均明显高于对照组[90．5％（19／21）比57．9％（11／19）、95．2％（20／21）比68．4％（13／19）]，CTFC值均明显低于对照组[（16±3）帧比（27±4）帧、（15±4）帧比（26±4）帧]，差异均有统计学意义（均P〈0．05）。2组患者用药前及用药后10min冠状动脉内有创血压比较差异均无统计学意义（均P〉0．05）。结论自制微导管经冠状动脉注射硝普钠及替罗非班能明显改善PCI术中的无复流现象，安全易行。Objective To explore the effect of intra-coronary application of nitroprusside and tirofiban through home-made microcatheter on no-reflow phenomenon during percutaneous coronary intervention （PCI）. Methods Twenty-one acute coronary syndrome （ACS） patients who had no-reflow phenomenon after PCI from December 2014 to December 2015 in the First Affiliated Hospital of Xi＇an Jiaotong University were enrolled as observation group; nineteen ACS patients who had no-reflow phenomenon after PCI from July 2014 to December 2015 the First Affiliated Hospital of Xinxiang Medical University were enrolled as control group. When no-reflow phenomenon occurred during PCI, the control group was injected nitroglycerin and tirofiban through guiding catheter; the observation group was injected nitroprusside and tirofiban through home-made microcatheter. At 1, 10 min after injection, coronary angiographic results, including thrombolysis in myocardial infarction （TIMI） grade and corrected TIMI frame count（ CTFC）, were analyzed. At 10 min after injection, coronary invasive blood pressure （IBP） was analyzed. Results At 1, 10 min after drug injection, rates of TIMI coronary flow grade 3 in observation group were significantly higher than those in control group [90.5% （19/21） vs 57.9% （11/19）, 95.2% （20/21） vs 68.4% （13/19） ] （P 〈0.05） ;CTFC values in observation group were significantly lower than those in control group[ （ 16 ±3） frame vs （27 ±4） frame, （ 15 ±4）frame vs （26 ±4） frame] （P 〈0.05）. Coronary IBP had no significant difference between groups. Conclusion Intra-coronary injection of nitroprusside and tirofiban through home-made microcatheter can safely and effectively prevent no-reflow phenomenon during PCI.

关 键 词：经皮冠状动脉介入 无复流 硝普钠 替罗非班 

分 类 号：R654[医药卫生—外科学]