单纯血栓抽吸及联合冠脉内注射替罗非班和前列地尔对急诊PCI无复流患者的临床疗效  

Clinical Application Value of Thrombus Aspiration Alone and Combined Intracoronary Injection of Tirofiban and Alprostadil with No-reflow in Patients during Emergency PCI

作　　者：李丰伟[1] 张振建[1] 钱进[1] 姚维[1] 王能[1] 

机构地区：[1]湖北医药学院附属随州医院心血管内科,随州441300

出　　处：《微循环学杂志》2017年第1期29-33,38,共6页Chinese Journal of Microcirculation

摘　　要：目的:观察单纯血栓抽吸、冠脉内注射替罗非班和前列地尔以及两种方法联用对急性心肌梗死(AMI)患者急诊经皮冠脉介入治疗(PCI)后无复流的临床疗效。方法:连续纳入冠脉造影无复流的AMI患者105例,采用随机数字表法分为单纯血栓抽吸组(A组),冠脉内注射替罗非班和前列地尔组(B组),血栓抽吸联合冠脉内注射替罗非班和前列地尔组(C组),每组35例。超声心动图观察各组术后1周左室舒张末径(LVEDD)和左室射血分数(LVEF);化学发光法检测各组患者术后1周血浆B型利钠肽(BNP)、肌钙蛋白I(cTnI);术后6个月冠脉造影评估各组心肌梗死溶栓(TIMI)血流分级、心肌灌注(TMPG)血流分级;比较术后6个月各组不良心血管事件(MACE)发生率。结果:治疗后1周B组BNP、cTnI水平明显高于A组,C组分别低于A组和B组(均P<0.05)。治疗后1周B组LVEF值明显低于A组,C组明显高于A组和B组;治疗后1周B组LVEDD值明显高于A组,C组明显低于A组和B组(均P<0.05)。治疗后6个月C组患者TIMI 3级和TMPG 3级比率分别高于A组和B组,差异具有统计学意义(P<0.05)。出院后6个月,MACE发生率B组低于A组,C组更低,差异均有统计学意义(P<0.01)。结论:血管抽吸联合冠脉内注射替罗非班和前列地尔可以使PCI无复流患者获得更好的心肌灌注,改善近期心功能,降低不良事件发生率。Objective：To observe the effect of thrombus aspiration alone,intracoronary injection of tirofiban and alprostadil and two methods combined with acute myocardial infarction（AMI）undergoing emergency percutaneous coronary intervention（PCI）clinical curative effect with no-reflow.Method：105consecutive patients with AMI who were consecutively enrolled in coronary angiography with no-reflow.They were randomly divided into simple thrombus aspiration group（A group）,intracoronary injection of tirofiban and alprostadil group（B group）,thrombus aspiration combined with intracoronary injection of tirofiban and alprostadil group（C group）,each group included 35 patients.Echocardiography,left ventricular end diastolic diameter（LVEDD）and left ventricular ejection fraction（LVEF）were observed 1weeks after operation.Plasma B type natriuretic（BNP）and cardiac troponin I（cTnI）were detected by chemical luminescence method after 1weeks.Coronary artery angiography（TIMI）blood flow and myocardial perfusion（TMPG）blood flow grade were assessed.Finally,the incidence of adverse cardiovascular events（MACE）was compared after 6months.Results：BNP and cTnI levels in the B group were significantly higher than those in the A group at 1weeks after treatment,and the C group was lower than that in the A group and the Bgroup（both P〈0.05）.The LVEF value of B group was significantly lower than that of A group at 1weeks after treatment,the C group was significantly higher than that of A group and B group,the LVEDD value of B group was significantly higher than that of A group at the end of treatment,the C group was significantly lower than that of A group and B group（P〈0.05）.6months after treatment,the levels of TIMI 3and TMPG 3in C group were higher than those in A group and B group,and the difference was statistically significant（P〈0.05）.6months after discharge,the incidence of MACE in B group was lower than that in A group,C group was lower,the difference was statistically significant�

关 键 词：血栓抽吸 替罗非班和前列地尔冠脉注射 经皮冠脉介入治疗无复流 临床疗效 

分 类 号：R542.22[医药卫生—心血管疾病]