血栓抽吸联合冠状动脉内替罗非班对STEMI患者PCI治疗后心功能及短期预后的影响  

Effects of thrombus aspiration combined with tirofiban on cardic function and short-term prognosis after PCI in patients with STEMI

作　　者：孙显东[1] 杨波[1] 胡文宇[1] 

机构地区：[1]赤峰市医院心内一科,内蒙古赤峰024000

出　　处：《岭南心血管病杂志》2017年第1期40-44,55,共6页South China Journal of Cardiovascular Diseases

摘　　要：目的评价血栓抽吸联合冠状动脉内替罗非班对ST段抬高型心肌梗死(ST-segment elevation myocardialinfarction,STEMI)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后心功能及短期预后的影响。方法选取2014年6月至12月在赤峰市医院接受PCI治疗的STEMI患者108例,按随机数字表法随机分为血栓抽吸+冠状动脉内替罗非班组(试验组)和单纯血栓抽吸组(对照组),比较两组PCI治疗后心功能及临床预后。结果试验组PCI治疗后即时心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流3级灌注比例显著高于对照组(P<0.05);无复流/慢血流(TIMI≤2级和0~1级)比例低于对照组(P<0.05);TIMI心肌灌注(TIMI myocardial perfusion,TMP)3级比例高于对照组(P<0.05),而TMP 0~1级和2级比例则显著低于对照组(P<0.05);校正的TIMI计帧数(corrected TIMI flame counts,CTFC)、手术总时间均低于对照组(P<0.05);而术后2 h 50%ST段恢复比例高于对照组(P>0.05),差异均有统计学意义;两组术中药物洗脱支架使用比例比较,差异无统计学意义(P>0.05)。住院期间试验组肌酸激酶同工酶(creatine kinase isoenzyme MB,CK-MB)、心肌肌钙蛋白I(cardiac troponin I,c Tn I)和高敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)峰值浓度均显著低于对照组,而且CK-MB、c Tn I、hs-CRP达峰时间小于对照组,差异有统计学意义(P<0.05)。住院期间两组均无心肌内出血患者,再次心肌梗死发生率及病死率组间比较,差异无统计学意义(P>0.05)。PCI治疗后1周两组左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期容积指数(left ventricularend-diastolic volume index,LVEDVI)、左心室收缩末期容积指数(left ventricular end-systolic volume index,LVESVI)和室壁运动积分指数(wall motion score index,WMSI)比较,差异无统计学意义(P>0.05);术后6个月试验组LVEF高于对照组,差异有统计学意义(P<0.05);而WMSI低于对照组Objectives To evaluate the cardiac function and prognosis of ST-segment elevation myocardial infarction（STEMI）patients who accepted thrombectomy combined with tirofiban in percutaneous coronary intervention（PCI）.Methods From June 2014 to December 2014,108 STEMI patients undergoing PCI in Chifeng Hosipital were ran-domly divided into thrombus aspiration＋ tirofiban group（test group）and thrombus aspiration group（control group）.Cardiac function and prognosis were compared between the two groups.Results Patients percentage of thrombolysis inmyocardial infarction（TIMI）blood flow grade 3 in test group instantly after PCI was significantly higher than that ofcontrol group（P〈0.05）,while patients percentage of no reflow/slow flow（TIMI≤grade 2 and grade 0-1e）in testgroup was lower than that of control group（P〈0.05）.Patients percentage of TIMI myocardial perfusion（TMP）grade3 in test group was higher than that of control group（P〈0.05）,while the proportions of TMP grade 0-1 and 2 weresignificantly lower than those of control group（P〈0.05）.Corrected TIMI flame count（CTFC）,total operation durationof test group were lower than those of control group（P〈0.05）,but 50% ST-segment after 2 h recovery ratio was higher（P〉0.05）.There was no significant difference in drug-eluting stents used proportion between the two groups（P〉0.05）.Peak concentrations of creatine kinase isoenzyme MB（CK-MB）,cardiac troponin I（c Tn I）and hypersensitive C-reactiveprotein（hs-CRP）in test group during hospitalization were significantly lower than those in control group（P〈0.05）.Duration of reaching peak concentrations of CK-MB,c Tn I,hs-CRP in test group was lower than those in control group（P〈0.05）.There were no cases of myocardial hemorrhage during hospitalization.There were no differences in infarctionrecurrence and mortality incidence between the two groups（P〉0.05）.No significant difference in left ventricularejection fraction（LVEF）,left ventricula

关 键 词：心肌梗死 血栓抽吸 替罗非班 血管成形术 经腔 经皮冠状动脉 

分 类 号：R542.22[医药卫生—心血管疾病]