冠状动脉内注射替罗非班对经皮冠状动脉介入术中无复流现象的疗效  

Effects of intracoronary arterial injection of tirofiban on no reflow treatment in patients with acute ST-segment elevation myocardial infarction underwent primary percutaneous coronary intervention

作　　者：段宏宇[1] 万喜平 李冰[1] 

机构地区：[1]内蒙古医科大学第三附属医院心内科,包头014010

出　　处：《中国心血管杂志》2017年第2期117-120,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的比较急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入术(PCI)中出现无复流时,冠状动脉内推注替罗非班和硝普钠的疗效比较。方法选择PCI术中出现无复流现象的STEMI患者68例,用随机数字表法分为替罗非班组和硝普钠组,每组各34例。针对PCI术中出现的无复流现象,两组经微导管向冠状动脉分别迅速注入替罗非班或硝普钠,10 min后行冠状动脉造影进行靶血管TIMI血流分级;术前及术后24 h监测血浆B型利钠肽水平(BNP)、术后30 d超声心动图测定左室射血分数(LVEF)和左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)。结果替罗非班组达到TIMI 3级血流比例明显高于硝普钠组[76.5%(26/34)比52.9%(18/34),P=0.03]。术前两组BNP水平差异无统计学意义(P=0.16),术后24 h替罗非班组BNP明显低于硝普钠组[(439.00±4.90)μmol/L比(632.00±3.63)μmol/L,P=0.02],术后30 d替罗非班组左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)均优于硝普钠组(均为P<0.05)。结论对于急诊PCI术中发生的无复流现象,替罗非班疗效优于硝普钠,冠状动脉内注射替罗非班可以增加STEMI患者PCI术中无复流现象后冠状动脉血流和心肌组织灌注,改善远期预后。Objective To compare the effect of intracoronary injection of tirofiban and sodium nitroprusside（SNP） on no reflow phenomenon during primary percutaneous coronary intervention （PCI）in patients with acute ST-segment elevation myocardial infarction（STEMI）. Methods A total of 68 patients with acute STEMI who had no reflow phenomenon during PCI were randomly divided into SNP group（ n = 34） and tirofiban group （ n = 34 ） . Intracoronary injection of tirofiban was given in tirofiban group, while intracoronary bolus SNP was given in SNP group, TIMI flow grade of infarct-related artery was recorded after 10 minutes. Plasma brain natriuretic peptide （BNP） before and 24 hours after PCI, left ventricular ejection fraction（ LVEF ）, left ventricular end-diastolic dimension （ LVEDD ） , left ventricular end-systolic dimension （LVESD） were recorded and compared after 30 days. Results The rate of TIMI grade 3 blood flow in tirofiban group was significantly greater than SNP group （76. 5% vs. 52. 9%, P = 0. 03 ）. BNP levels were similar between the two groups before PCI （P = 0. 16 ）, but in tirofiban group were significantly lower than SNP group after PCI [ （ 439. 00 ± 4. 90 ） μmol/L vs. （ 632.00 ± 3.63 ） μmol/L, P = 0. 021. LVEF, LVEDD, LVESD at 30 days in tirofiban group were significantly higher than those in SNP group（ all P 〈 0.05 ）. Conclusions Intracoronary injection of tirofiban is superior to SNP in improving no-reflow phenomenon after primary PC1 in STEMI patients. Tirofiban therapy can increase coronary blood flow and myocardial perfusion after occurring of no-reflow phenomenon during primary PCI in STEMI patients,improve long-term prognosis.

关 键 词：血管成形术 经腔 经皮冠状动脉 无复流现象 替罗非班 硝普钠 

分 类 号：R542.22[医药卫生—心血管疾病]