依替巴肽三种给药途径在高血栓负荷急性ST段抬高型心肌梗死PCI中的效果  

Clinical effects of three route of etibatide administration in PCI of acute ST segment elevation myocardial infarction with high thrombotic load

作　　者：陈杰[1] 张斌[1] 陈丹[1] 周志超[1] CHEN Jie;ZHANG Bin;CHEN Dan;ZHOU Zhi-chao(Department of Cardiology,Central People s Hospital of Zhanjiang,Zhanjiang,Guangdong 524045,China)

机构地区：[1]湛江中心人民医院心内科,广东湛江524045

出　　处：《中国临床研究》2022年第5期655-659,664,共6页Chinese Journal of Clinical Research

基　　金：广东省医学科学技术研究基金(B2020226)。

摘　　要：目的探讨依替巴肽三种给药途径在高血栓负荷急性ST段抬高型心肌梗死(STEMI)经皮冠状动脉介入术(PCI)中的临床效果。方法选取2018年5月至2021年7月在湛江中心人民医院诊治的300例高血栓负荷的急性STEMI患者作为研究对象。随机分为A、B、C组,每组100例。3组均行PCI,A组静脉推注依替巴肽,B组在冠状动脉内注入依替巴肽,C组在病变部位注入依替巴肽。对比3组的梗死心外膜大血管血流灌注水平、PCI术后心肌微循环指标、心肌损伤面积指标、住院期间出血情况和3个月随访结果。结果与A组相比,B组和C组的心肌呈色分级、左心室射血分数(LVEF)均升高,校正TIMI帧幅数(cTFC)、磷酸肌酸激同工酶(CK-MB)、CK-MB峰值、肌钙蛋白I(cTnⅠ)、cTnⅠ峰值、N-末端B型利钠肽前体(NT-proBNP)水平和心脏不良事件(MACE)总发生率均降低,ST段回落程度均明显大(P<0.05)。与B组相比,C组的心肌呈色分级、LVEF均升高,cTFC、CK-MB、CK-MB峰值、cTnⅠ、cTnⅠ峰值、NT-proBNP水平和MACE总发生率均降低,ST段回落程度明显大(P<0.05)。结论在高血栓负荷急性STEMI PCI中,病变部位注入依替巴肽在改善心肌微循环灌注、减轻心肌损伤面积、PCI术后心功能及降低MACE方面的效果最好,冠状动脉内注入依替巴肽次之。Objective To investigate the clinical effects of three route of etibatide administration in percutaneous coronary intervention(PCI)of acute ST-segment elevation myocardial infarction(STEMI)with high thrombotic load.Methods A total of 300 patients with acute STEMI with high thrombus burden treated in Central People s Hospital of Zhanjiang from May 2018 to July 2021 were selected and randomized to group A,B and C,with 100 cases in each group.PCI was performed in all three groups,etibatide was injected intravenously in group A,etibatide was injected into the coronary artery in group B,and etibatide was injected into the lesion site in group C.The blood perfusion level of epicardial vessels,myocardial microcirculation index,myocardial injury area index,bleeding during hospitalization and 3-month follow-up results were compared among three groups.Results Compared with group A,the myocardial color grading,left ventricular ejection fraction(LVEF)in group B and group C were significantly higher,corrected TIMI frame number(cTFC),creatine kinase isoenzyme(CK-MB),CK-MB peak,troponin I(cTn I),cTn I peak,N-terminal B-type natriuretic peptide precursor(NT-proBNP)level and the total incidence of adverse cardiac events(MACE)in group B and group C were significantly lower,the degree of ST segment decline in group B and group C were significantly greater(P<0.05).Compared with group B,the myocardial color grading,LVEF in group C were significantly higher,cTFC,CK-MB,CK-MB peak,cTn I,cTn I peak,NT-proBNP level and the total incidence of MACE in group C were significantly lower,the degree of ST segment decline in group C were significantly greater(P<0.05).Conclusions In PCI of acute STEMI with high thrombotic load,injection of etibatide into the lesion site has the best effect in improving myocardial microcirculation perfusion,reducing myocardial injury area,cardiac function after PCI,and reducing MACE after PCI,followed by intracoronary injection of etibatide.

关 键 词：高血栓负荷 心肌梗死 急性ST段抬高型 经皮冠状动脉介入术 依替巴肽 用药途径 

分 类 号：R542.22[医药卫生—心血管疾病]