冠状动脉闭塞段注入替罗非班对急性心肌梗死合并糖尿病患者血流影响的临床分析  

Influence of intravascular tirofiban injection in occlusion site of coronary artery on patients with acute myocardial infarction complicated with diabetes mellitus

作　　者：何小萍[1] 苏少辉[1] 叶健烽[1] 林爱玲[1] 李大强[1] 卢炯斌[1] He Xiaoping;Su Shaohui;Ye Jianfeng;Lin Ailing;Li Daqiang;Lu Jiongbin(Department of Cardiology ,Dongguan People's Hospital,Dongguan 523000, China)

机构地区：[1]东莞市人民医院心内科,523000

出　　处：《中国心血管杂志》2016年第3期231-235,共5页Chinese Journal of Cardiovascular Medicine

基　　金：广东省医学科研基金项目(B2012383)~~

摘　　要：目的通过在急诊介人治疗时对急性心肌梗死合并糖尿病患者的冠状动脉闭塞段注人替罗非班，观察其对无复流、慢血流现象及心功能的影响。方法选取我院2012年3月至2015年1月收住的123例急性心肌梗死合并糖尿病患者，根据研究目的采用简单随机化方法，通过计算机产生随机数来进行随机分组，分为A、B两组。A组59例为血栓抽吸联合冠状动脉口处注射替罗非班;B组64例为血栓抽吸联合血栓抽吸导管直接在冠状动脉闭塞段内注人替罗非班。对比两组冠状动脉注人替罗非班前后无复流发生率及术后半年内心功能的变化，观察其治疗效果。结果两组患者术后1个月左心室射血分数、左心室舒张末径、6mm步行试验差异均无统计学意义（均为P>0.05)，而术后3和6个月则差异显著（均为P<0.05)。两组患者TIMI血流n级所占比例最高(83.1%和85.9%)，B组发生无复流现象的比例低于A组(7.8%比11.9%夕=7.319，P=0.023)，主要不良心血管事件发生率低于A组(6.3%比结论经皮冠状动脉介人治疗术中在冠状动脉闭塞段直接注人替罗非班，可有效降低急性心肌梗死合并糖尿病患者术后无复流现象的发生，改善心功能。Objective No reflow,slow flow,and cardiac function were observed in patients of acute myocardial infarction ( AMI) with diabetes mellitus ( DM ) during emergency intervention treatment by tirofiban injection on the occlusion segment of coronary artery. Methods A total of 123 AMI combined with DM patients were enrolled into this study from March 2012 to January 2015 in our hospital. Simple randomization was used according to a randomized number which was generated by comouter. There were 59 cases in goup A which represented thrombus aspiration combined with tirofiban injection on ostium of coronary artery. Another 64 cases were in group B, which meant thrombus aspiration combined with direct injection of tirofiban in occlusion segment, of coronary artery. No reflow incidence and cardiac function were evaluated before and after tirofiban injection and half of year. Results Left ventricular ejection fraction (LV EF), left ventricular end-diastolic diameter ( LVEDD) , 6 minutes walk test (6M W T) were not significantly different after one month of surgery (P > 0. 05 ) . LVEF, LVEDD, 6MWT were significantly different after 3 and 6 months of surgery ( P < 0. 05 ). TIMI flow of grade IH accounted for highest proportionin both grouos (83. 1% and 85. 9% ) . No reflow incidence in group B was lower than in group A (7. 8% vs. 11. 9% -1 . 319,P =0. 023). The main adverse cardiovascular events was lower in group B than group A (6. 3% 仍 18.6% ,尤2 = 7.789,_P = :0. 016). Conclusions No reflow incidence decrease and cardiac function is improved by tirofiban injection in occlusion segment of coronary artery during percutaneous intervention on AMI patients complicated with DM.

关 键 词：急性心肌梗死 糖尿病 冠状动脉闭塞 无复流现象 替罗非班 

分 类 号：R542.22[医药卫生—心血管疾病] R587.1[医药卫生—内科学]