替罗非班和硝普钠冠脉内注射辅助血栓抽吸用于急性心肌梗死患者PCI的价值  

Value of intracoronary tirofiban and nitroprusside injection combined thrombus aspiration in patients with AMI undergoing emergency PCI

作　　者：林文果[1] LIN Wen-guo(Department of Cardiology,Second Peoples Hospital of Yibin City,Yibin,Sichuan,644000,China)

机构地区：[1]宜宾市第二人民医院心血管内科,四川宜宾644000

出　　处：《心血管康复医学杂志》2018年第4期420-424,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:探讨替罗非班和硝普钠冠脉内注射辅助血栓抽吸用于重度血栓负荷前壁急性心肌梗死患者急诊PCI的价值。方法:选择我院92例重度血栓负荷前壁急性心肌梗死患者,随机均分为替罗非班组(替罗非班冠脉内注射)和联合治疗组(替罗非班联合硝普钠冠脉内注射),各46例,均辅助血栓抽吸。对比两组术前、术后7d梗死相关动脉(IRA)血流心肌梗死溶栓试验(TIMI)分级、TIMI心肌灌注(TMP)分级,心肌损伤标志物、心功能、心电图ST段回落变化及1个月内心血管事件、出血事件发生率。结果:与术前比较,术后7d两组肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)水平均明显升高,左室舒张末期内径(LVEDd)明显增加,LVEF明显下降(P均<0.01);但术后两组上述指标比较无显著差异(P均>0.05)。与替罗非班组比较,联合治疗组术后IRA血流TIMI 3级(63.04%比86.96%)及TMP 3级比例(52.17%比76.09%)、ST段完全回落率(45.65%比71.74%)明显提高(P<0.05或<0.01)。两组出血事件、心血管事件发生率比较无显著差异(P均>0.05)。结论:替罗非班联合硝普钠与单纯替罗非班冠脉内注射辅助血栓抽吸用于重度血栓负荷前壁急性心肌梗死急诊患者PCI在减轻心肌损伤及改善心功能方面效果相当,但前者可改善心肌再灌注状态,降低慢血流或无复流发生率,提高心电图ST段完全回落率。Objective： To explore value of intracoronary tirofiban and nitroprusside injection combined thrombus aspiration （TA） in patients with acute anterior myocardial infarction （AAMI） and heavy thrombus burden undergoing emergency per- cutaneous coronary intervention （PCI）. Methods： A total of 92 AAMI patients with heavy thrombus burden were selected from our hospital. They were randomly and equally divided into tirfiban group（received intracoronary tirofiban injection combined TA） and combined treatment group （received intracoronary tirofiban and nitroprusside injection combined TA）. TIMI blood flow grade of infarct related artery （IRA）, TIMI myocardial perfusion grading （TMP）, myocardial injury markers, cardiac function and ST segment regression of ECG before and 7d after PCI, incidence rates of cardiovascular e- vents and hemorrhage events within one month were compared between two groups. Results： Compared with before PCI, there were significant rise in levels of creatine kinase isoenzyme MB （CK-MB） and cardiac troponin I （cTnI） and left ventricular end-diastolic dimension （LVEDd）, and significant reduction in LVEF on 7d after PCI in two groups, P〈0.01 all, but there were no significant difference in above indexes between two groups after PCI, P〉0.05 all. Compared with tirofiban group after PCI, there were significant rise in percentages of TIMI blood flow grade 3 of IRA 〈63.04% vs. 86.96%） and TMP grade 3 （52.17% vs. 76.09%）, and ST segment complete regression rate （45.65% vs. 71.74%） in combined treatment group, P〈0.05 or %0.01. There were no significant difference in incidence rates of hemorrhage and cardiovascular events between two groups, P〉0.05 both. Conclusion： Compared with pure intracoronary tirofiban injection combined TA, intracoronary tirofiban and nitroprusside injection com- bined TA possesses similar effects in relieving myocardial injury and improving cardiac function in emergency PCI patietns with AAMI and heavy thrombus bur

关 键 词：前壁心肌梗死 血栓栓塞 硝普钠 替罗非班 

分 类 号：R542.22[医药卫生—心血管疾病]