地尔硫对急性心肌梗死患者急诊冠状动脉介入治疗中无再流的作用

Effects of intracoronary diltiazem on no-reflow phenomenon after emergent percutaneous coronary intervention in patients with acute myocardial infarction

目的：评价冠状动脉内应用地尔硫[艹卓]对急性心肌梗死（AMI）患者急诊经皮冠状动脉腔内成形和支架术（PTCA／Stenting）后梗死相关动脉无再流现象的疗效。方法：AMI急诊PTCA／Stenting后再通的梗死相关动脉存在无再流现象者34例。1999年1月至2002年4月16例患者（尿激酶组），冠状动脉内注射尿激酶30×10^4～50×10^4u，2002年5月至2005年8月18例患者（地尔硫[艹卓]组），冠状动脉内注射地尔硫蕈0．5～2．0mg，15～30min内注完；注射完毕15min再行冠状动脉造影，评定冠状动脉血流TIMI分级。结果：尿激酶组治疗后冠状动脉血流，11．M1分级无明显变化，地尔硫[艹卓]组治疗后冠状动脉血流TIMI分级明显增加（1．0VS．2．44，P〈0．01）。治疗后冠状动脉血流TIMI分级地尔硫[艹卓]组高于尿激酶组（2．44VS．1．43，P〈0．05），达TIMI3级患者地尔硫蕈组明显多于尿激酶组（66.7％VS．12．5％，P〈0．01）。结论：冠状动脉内应用地尔硫[艹卓]0．5～2．0mg能有效改善AMI急诊PTCA／Stenting术无再流现象。

Objective To assess the effects of intracoronary diltiazem on no-reflow phenomenon of infarct-related artery （IRA） after emergent percutaneous transluminal coronary angioplasty or/and intracoronary stenting （PTCA/Stenting） in the patients with acute myocardial infarction （AMI）. Methods We studied 34 AMI patients with no-reflow phenomenon of IRA after emergent PTCA/Stenting between January 1999 and August 2005. Urokinase-treated group （ n = 16 ） was given intracoronary urokinase 300 000 -500 000 units within 15 - 30 minutes between January 1999 and April 2002 while dihiazemtreated group （ n = 18） was given intracoronary dihiazem 0.5 -2 mg within 10 -30 minutes between May 2002 and August 2005. Fifteen minutes later, coronary arteriography （CAG） was performed and the thrombolysis in myocardial infarction （TIMI） flow grade was measured. Results No apparent change of TIMI flow grade was found between pre-administration and post-administration of intracoronary urokinase, but TIMI flow grade was significantly improved after intracoronary diltiazem （ P 〈 0. 01 ）. TIMI flow grade of diltiazem-treated group was significantly higher than that of urokinase-treated group after the administration （ P 〈 0. 05 ）. The percentage of the patients who reached TIMI flow grade 3 after the intracoronary administration was higher in the dihiazemtreated group than that in the urokinase-treated group （P 〈 0.01 ）. Conclusion The intracoronary administration of dihiazem 0.5 - 2 mg can effectively improve the no-reflow phenomenon after emergent PTCA/Stenting in patients with AMI.