冠脉内注射替罗非班和尼可地尔对改善急诊经皮冠状动脉介入治疗无复流的疗效观察  

Effect of intracoronary tirofiban combined with nicorandil injection on recovery of coronary flow during primary percutaneous coronary intervention on STEMI

作　　者：梁文武[1] 王红[1] 李华珍[1] LIANG Wenwu;WANG Hong;LI Huazhen(Department of Internal Medicine-Cardiovascular,The Forth Affiliated Hospital of Guangxi Medical University,Liuzhou,Guangxi 545005,China)

机构地区：[1]广西医科大学第四附属医院心内科,广西柳州545005

出　　处：《重庆医学》2018年第A01期38-40,共3页Chongqing medicine

摘　　要：目的观察冠脉内注射替罗非班和尼可地尔对减少急诊经皮冠状动脉介入无复流或慢血流的疗效。方法184例急性ST段抬高型心肌梗死行急诊经皮冠状动脉介入治疗的患者分为3组,A组于球囊扩张前予冠脉内注射替罗非班和硝酸甘油,B组于球囊扩张前予冠脉内注射替罗非班和尼可地尔,C组在球囊扩张前后不予冠脉内注射药物。各组病例在球囊扩张前根据血栓负荷情况决定是否进行血栓抽吸。观察各组治疗后梗死相关血管血流、住院期间心血管不良事件和出血并发症。结果3组患者的临床基线特征、血栓抽吸和冠脉病变特征无差异显著性。3种不同方式的处理方法,急诊经皮冠状动脉介入治疗后无复流和慢血流发生率各组间差异有统计学意义(P<0.05),A组和B组发生率低于C组(P均<0.05),且B组发生率低于A组(P<0.05)。A组和C组、B组和C组住院期间心血管不良事件发生率比较,差异有统计学意义(P<0.05),但A组和B组间比较差异无统计学意义(P>0.05))。各组住院期间出血并发症比较差异无统计学意义(P>0.05)。结论急诊冠状动脉介入治疗时冠脉内注射替罗非班和血管扩张剂,可有效改善梗死相关血流,尼可地尔的疗效优于于硝酸甘油。Objective To explore the effect of intracoronary Tirofiban combined with Nicorandil injection on recovery of coronary flow during primary percutaneous coronary intervention(PPCI)on ST-segment elevation acute myocardial infarction(STEMI).Methods A total of 184 patients with STEMI were assigned to group A(intracoronary Tirofiban combined with Nitroglycerin)(n=61)],group B(intracoronary Tirofiban combined with Nicorandil)(n=82)and group C(without anything intracoronary injection)(n=41).Thrombus aspiration were performed on patients with heavy thrombus burden.Intracoronary drug injection were performed before balloon dilation.To observe the flows of the infarct-related artery(IRA),the main cardiovascular events and bleeding complication in-hospital.Results The baseline clinical data,angiographic features and the cases of thrombus aspiration among 3 groups were similar(P>0.05).There was significantly different on the flow of IRA after PCI among 3 groups(P<0.05).The flows of IRA after PCI in group A and group B was better than group C(P<0.05),and group B was better than group A(P<0.05).The percentage of the maim cardiovscular events in-hospital was similar between group A and group B,but there were significantly different between group C and group A or group B(P<0.05).There were no significantly different on bleeding complication after PCI among 3 groups(P>0.05).Conclusion The result of our research suggests that there were benefit by intracoronary Tirofiban combined with vasodilator during PPCI,and the effect of Nicorandil was better than Nitroglycerin.

关 键 词：替罗非班 尼可地尔 经皮冠状动脉介入治疗 急性心肌梗死 

分 类 号：R654.2[医药卫生—外科学]