经抽吸导管冠状动脉内注射替罗非班在SETMI急诊介入中的应用研究  

Application of intracoronary injection of tirofiban through aspiration catheter during emergency intervention for ST-segment elevation myocardial infarction

作　　者：孟祥茹[1] 王红伟[1] 金艳 吕平[1] Meng Xiangru;Wang Hongwei;Jin Yan;Lv Ping(Zhuozhou Municipal Hospital, Baoding City, Hebei Province, Baoding 072750, China)

机构地区：[1]河北省保定涿州市医院心内科,保定072750

出　　处：《中国循证心血管医学杂志》2017年第11期1338-1341,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：保定市科学技术研究发展指导计划2015(15ZF060)

摘　　要：目的探讨经血栓抽吸导管于冠状动脉(冠脉)病变处注射替罗非班在急性ST段抬高型心肌梗死(STEMI)急诊经皮冠脉介入(PCI)术中的疗效。方法连续入选2014年3月~2016年3月于河北省保定涿州市医院收治的138例拟行PCI术的STEMI患者,随机分为3组:替罗非班Ⅰ组(46例):血栓抽吸+经抽吸导管于病变处注射替罗非班+PCI,替罗非班Ⅱ组(46例):血栓抽吸+指引导管冠脉内注射替罗非班+PCI,对照组(46例):血栓抽吸+PCI。分析治疗后3组患者血流恢复情况和心功能指标改善情况。结果 PCI术后冠脉造影结果显示:替罗非班Ⅰ组TMPG 3级比率高于对照组,替罗非班Ⅰ组无复流比率均低于替罗非班Ⅱ组和对照组,替罗非班Ⅰ组慢复流比率低于对照组(P均<0.05),替罗非班Ⅰ组血流恢复情况好于替罗非班Ⅱ组和对照组。替罗非班Ⅰ组ST段回落指数(STR)>50%比率高于对照组,替罗非班Ⅰ组肌酸激酶同工酶(CK-MB)峰值时间均较替罗非班Ⅱ组和对照组提前,替罗非班Ⅰ组肌钙蛋白Ⅰ(cTnI)峰值时间较对照组提前(P均<0.05)。PCI术后7 d,替罗非班Ⅰ组左室射血分数(LVEF)高于对照组,替罗非班I组左心室舒张末期内径(LVEDD)均低于替罗非班Ⅱ组和对照组(P均<0.05)。PCI术后1月,替罗非班Ⅰ组主要心血管不良事件(MACE)发生率均低于替罗非班Ⅱ组和对照组(P<0.05)。结论 STEMI患者PCI术中,血栓抽吸联合经血栓抽吸导管于病变处注射替罗非班可有效恢复冠脉血流,减少无复流、慢血流的发生,改善心肌灌注和心功能,同时降低MACE发生率,有助于改善STEMI患者预后。Objective To investigate the curative effect of tirofiban injection at site of coronary artery lesion through thrombus aspiration catheter during percutaneous coronary intervention(PCI)for treating acute ST-segment elevation myocardial infarction(STEMI).Methods STEMI patients(n=138)planed to receive PCI were chosen from the Zhuozhou Municipal Hospital of Baoding City of Hebei Province from Mar.2014to Mar.2016.All patients were randomly divided into tirofiban groupⅠ(thrombus aspiration+tirofiban injection through aspiration catheter+PCI),tirofiban groupⅡ(thrombus aspiration+tirofiban injection through guiding catheter+PCI),and control group(thrombus aspiration+PCI,each n=46).The recovery of blood flow and improvement of heart function indexes were analyzed in3groups after treatments.Results The results of coronary angiography showed that the percentage of patients with TMPG grade3was higher in tirofiban group I than that in control group,percentage of patients with no-reflow was lower in tirofiban group than that in tirofiban groupⅡand control group,and percentage of patients with slowreflow was lower in tirofiban groupⅠthan that in control group(all P<0.05).The recovery of blood flow was better in tirofiban group than that in tirofiban groupⅡand control group.The percentage of patients with ST-segment reduction index>50%was higher in tirofiban groupⅠthan that in control group,peak time of creatine kinase-MB isoenzyme(CK-MB)was advanced in tirofiban groupⅠcompared with tirofiban groupⅡand control group,and peak time of cardiac troponinⅠ(cTnI)was advanced in tirofiban groupⅠcompared with control group(all P<0.05).After PCI for7d,left ventricular ejection fraction(LVEF)was higher in tirofiban groupⅠthan that in control group,and left ventricular end-diastolic inner diameter(LVEDD)was lower in tirofiban groupⅠthan that in tirofiban groupⅡand control group(all P<0.05).After PCI for1month,the incidence of major adverse cardiovascular events(MACE)was lower in tirofiban groupⅠthan that in tiro

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

分 类 号：R542.22[医药卫生—心血管疾病]