冠状动脉内注射参麦注射液联合西药治疗急性心肌梗死介入术后冠状动脉无复流30例临床观察

Clinical Observation on Intracoronary Injection With Shenmai Injection and Western Medicine for No-Reflow After Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction

目的观察冠状动脉内注射参麦注射液治疗急性心肌梗死(AMI)经皮冠状动脉介入治疗(PCI)术后冠状动脉无复流的临床疗效及其安全性。方法 60例AMI行PCI术后无复流患者随机分为对照组和治疗组各30例。对照组经指引导管冠状动脉内直接给予替罗非班注射液10μg/kg,3min内缓慢推注,治疗组在对照组基础上给予参麦注射液5ml经指引导管冠状动脉内直接注射。治疗前及治疗后5min、10min采用通用心肌梗死溶栓疗法(TIMI)血流分级评价患者冠状动脉血流恢复情况,观察术后2h、12h心电图ST段变化情况、术后7天内出血情况及30天内的主要心血管事件。结果两组治疗后TIMI血流分级均明显改善,治疗组治疗后10min TIMI 3级血流恢复例数明显高于对照组(P<0.05)。两组术后心电图ST段均明显下降,12h后治疗组仍有明显改善并且优于对照组(P<0.05)。两组患者7天内出血率及30天内主要心血管事件发生率比较,治疗组明显低于对照组(P<0.05)。结论冠状动脉内注射参麦注射液治疗AMI行PCI术后无复流安全有效。

Objective To study the efficacy and safety of intracoronary injection with Shenmai Injection for noreflow after percutaneous coronary intervention （PCI） in patients with acute myocardial infarction （AMI）. Methods Sixty cases of no-reflow after PCI in AMI patients were randomized into the treatment group and control group, with 30 in each. The control group was given intracoronary injection with 10 μg/kg Tirofiban Injection. The treatment group was added with 5 ml of Shenmai Injection. The thrombolysis in myocardial infarction （TIMI） flow was observed before and after treatment. Changes in electrocardiographic ST-segment, bleeding and main cardiovascular events within 30 days were observed. Results The TIMI flow was significantly restored in both groups after treatment, especially TIMI 3-grade flow in the treatment group 10 min after treatment （ P 〈 0. 05 ）. The electrocardiographic STsegment was significantly decreased in both groups after treatment, especially in the treatment group 12 h after treatment （ P 〈 0. 05 ）. The bleeding rate and incidence of main cardiovascular events within 30 days in the treatment group was significantly lower than that in the control group （ P 〈 0. 05 ）. Conclusion The intracoronary injection with Shenmai Injection is effective and safe for no-reflow after PCI in patients with AMI.