STEMI患者急诊PCI术中应用血栓抽吸导管注射维拉帕米和替罗非班的有效性和安全性  

Effectiveness and safety of injection of verapamil and tirofiban with thrombus aspiration catheter in STEMI patients during emergent PCI

作　　者：陈少源[1] 吴振垣 刘荣志 王执兵[1] 汪惠芝[1] 谢培益[1] 

机构地区：[1]广东医学院附属深圳南山医院心血管内科,深圳518052

出　　处：《中国循证心血管医学杂志》2017年第9期1083-1085,1088,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术中应用血栓抽吸导管注射维拉帕米和替罗非班的疗效及安全性。方法入选2015年1月~2016年4月于广东医学院附属深圳南山医院确诊的STEMI患者128例,其中男性96例,女性32例。按随机数字表法分为常规组(n=64)和实验组(n=64)。常规组通过指引导管冠状动脉口内联用维拉帕米和替罗非班;实验组通过血栓抽吸导管超选择性到达罪犯病变远端后同等剂量给药。观察患者PCI术后血流、校正的TIMI帧数(CTFC)、ST回落情况、肌酸激酶同工酶(CK-MB)、左室射血分数(LVEF),记录住院期间主要不良心血管事件(MACE)和不良反应情况。结果与常规组比较,实验组CTFC和CK-MB降低,ST回落比例和左室射血分数升高,[(27.47±5.58)帧vs.(23.43±4.57)帧]、[(97.63±15.32)U/L vs.(85.44±14.23)U/L]、(65.6%vs.81.2%)、[(42.78±7.80)%vs.(47.53±7.50)%],差异有统计学意义(P均<0.05)。两组不良反应和MACE发生率比较,差异无统计学意义(P均>0.05)。结论 STEMI患者急诊PCI术中应用血栓抽吸导管在冠状动脉罪犯病变远端注射维拉帕米和替罗非班可有效改善心肌灌注水平,临床使用安全性较高。Objective To investigate the curative effect and safety of injection of verapamil and tirofiban with thrombus aspiration catheter in patients with acute ST-segment elevation myocardial infarction （STEMI） during emergency emergent percutaneous coronary intervention （PCI）. Methods STEMI patients （n=128, male 96 and female 32） were chosen from the Shenzhen Nanshan Hospital affiliated to Guangdong Medical University from Jan. 2015 to Apr. 2016, and then they were divided into routine group （n=64） and test group （n=64） according to random digital table. The routine group was given verapamil and tirofiban through ostium of coronary artery by using guiding catheter, and test group was given the same dose of verapamil and tirofiban by using super-selective thrombus aspiration catheter after reached distal criminal lesion. The postoperative blood flow, corrected TIMI frame count （CTFC）, ST-segment resolution, creatine kinase-MB isoenzyme （CK-MB） and left ventricular ejection fraction （LVEF） were observed, and major adverse cardiovascular events （MACE） and adverse reactions were recorded during hospitalization. Results Compared with routine group, CTFC [（27.47±5.58） vs. （23.43±4.57）] and CK-MB [（97.63±15.32） U/L vs. （85.44±14.23） U/L] decreased, ST-segment resolution proportion （65.6% vs. 81.2%） and LVEF [（42.78±7.80）% vs. （47.53±7.50）%] increased in test group （all P〈0.05）. The difference in incidence of adverse reactions and MACE had no statistical significance between 2 groups （all P〉0.05）. Conclusion The injection of verapamil and tirofiban by using thrombus aspiration catheter at distal criminal lesion of coronary artery can effectively improve myocardial perfusion and has higher safety in STEMI patients during emergent PCI.

关 键 词：急性ST段抬高型心肌梗死 血栓抽吸导管 经皮冠状动脉介入治疗 维拉帕米 替罗非班 

分 类 号：R514.4[医药卫生—内科学]