经微导管注射维拉帕米对急诊PCI术中无复流现象的疗效

Effect of intra-microcatheter verapamil on no-reflow phenomenon during percutaneous coronary intervention for acute myocardial infarction

目的观察急诊经皮冠状动脉介入治疗(percutaneous coronary interventions,PCI)术中出现无复流现象后,经微导管向远端血管床注射钙离子拮抗剂的临床效果。方法研究组为2007年3月至2008年4月连续急诊PCI术中出现无复流现象的患者22例。对照组为2006年5月至2007年2月连续急诊PCI无复流者22例。研究组出现无复流现象后,送微导管至无复流血管远端,经微导管团注维拉帕米200μg。对照组采取常规处理方法,经指引导管冠状动脉内注射血管活性药物,观察注射药物后首次和手术结束前末次造影图像,评估心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流分级、TIMI心肌组织灌注分级(TIMI myocardial perfusion grades,TMPG)、PCI手术时间、X线暴露时间、术后1周左心室射血分数、住院期间主要心脏不良事件(major adversecardiovascular events,MACE)事件。结果研究组给药后首次造影TIMI-3级血流比例明显提高(21例vs 3例,P<0.01),手术结束前末次造影TIMI-3级血流比例仍较高(22例vs 9例,P<0.01)。首次和末次造影均显示研究组心肌组织灌注较对照组更佳,TMPG-3级的例数分别为19例vs 1例(P<0.01)和20例vs 6例(P<0.01)。研究组明显缩短介入手术时间(46.4±16.3)分钟vs(62.2±21.5)分钟(P<0.01),减少X线暴露时间(10.5±4.9)分钟vs(18.1±5.4)分钟(P<0.01),提高术后1周左心室射血分数(51.3±9.2)%vs(37.1±6.7)%(P<0.01),减少住院期间MACE事件(1例vs 6例,P<0.05)。结论经微导管向远端血管床注射维拉帕米,可以即刻提高靶血管血流灌注和心肌组织灌注,缩短手术时间,使急诊手术更加顺利,同时可以进一步改善心功能,减少MACE事件。临床实践中出现无复流现象后,该方法不失为一种简单有效提高血流灌注的方法。

Objective To study the effect of intra-microcatheter verapamil on no-reflow phenomenon during pereutaneous coronary intervention（PCI） for acute myocardial infaretion（AMI）. Methods From March 2007 to April 2008,22 consecutive patients with AMI who had no-reflow phenomenon during PCI were enrolled for intra- mierocatheter verapamil treatment. Intra-microcatheter 200μg verapamil to distal vascular bed of target vessel was administered. Retrospectively, 22 consecutive AMI patients from May 2006 to February 2007 .who had no-reflow phenomenon undergoing direct PCI and received conventional treatment were enrolled as control subjects. Thrombolysis in myocardial infarction（TIMI） flow grade and TIMI myocardial perfusion grade （TMPG） were assessed from the first contrastographic picture after drug administered and the end one of PCI. The times of PCI and X-ray exposure, left ventricle ejection fraction after one week and complications in hospital were compared. Results The patients treated with verapamil were significantly better in postprocedural TIMI-3 flow degree （21 eases vs 3 cases, P 〈0.01） and post-PCI （22 cases vs 9 cases, P 〈0.01）. The treated group was found to have higher rate of TMPG-3 in the first contrastographic picture after drug being administered（19 cases vs 1 case, P 〈0.01） and the last one of post-PCI （20 cases vs 6 cases, P 〈0.01）. The times of PCI （46.4±16.3） min vs （62.2±21.5） min（P〈0.01）,and X-ray exposure （10.5±4.9） min vs （18.1±5.4） min（ P 〈0.01）,left ventricle ejection fraction after one week （51.3±9.2）% vs （37.1±6.7） %（ P 〈0.01） ,and complications in hospital （1 case vs 6 cases, P〈0.05） of the two groups had statistical difference. Conclusion Intra-microcatheter verapamil on no-reflow phenomenon during PCI for AMI patients could implove perfusion instantly,which may have potential value of clinical application.