急诊经皮冠状动脉介入治疗前冠状动脉内注射盐酸替罗非班对急性ST段抬高型心肌梗死患者术中TIMI血流的影响

TIMI flow influence of intracoronary Tirofiban injection in patients with STEMI before primary PCI

目的探讨急诊经皮冠状动脉介入治疗(PCI)前冠状动脉内注射血小板膜糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂盐酸替罗非班对急性ST段抬高型心肌梗死(STEMI)患者术中TIMI血流的影响。方法入选北京大学首钢医院2005年4月至2007年8月急性STEMI冠状动脉造影(CAG)显示梗死相关血管(IRA)有血栓征象的患者67例,其中男性48例,女性19例,平均年龄57.4±8.1岁,随机分成试验组(PCI前冠状动脉内注射盐酸替罗非班+PCI,n=35)与对照组(直接PCI,n=32)。收集所有病例的临床和CAG资料,对比两组患者PCI术中IRA的TIMI血流情况。结果试验组PCI术中无复流的发生率明显低于对照组(2.86%比18.75%,P<0.05),IRA远端栓塞发生率试验组明显低于对照组(0%比15.63%,P<0.05)。结论急诊PCI前冠状动脉内缓慢注射盐酸替罗非班可以明显改善急性STEMI患者急诊PCI术中IRA远端的前向血流,降低无复流现象的发生率。

Objective To study TIMI flow influence of intracoronary injection of GP Ⅱ b/Ⅲ a receptor antagonists （tirofiban） in patients with STEMI before primary PCI. Methods Sixty-seven STEMI patients （48 male, mean age 57.4 ± 8.1 years old） admitted during April, 2005 to August, 2007 were included in the study and in all of them, IRA thrombus was found during CAG. The patients were divided into the primary PCI group （ n = 32） and primary PCI plus introcoronary tirofiban injection group （ n = 35 ）. Changes in TIMI flow were were obsurved diving the operation. Results The incidence of slow-flow and noreflow of the intracoronary tirofiban injection ＋ PCI group was lower than that of the primary PCI group （2. 86% vs 18.75% ,P 〈0. 05）; and embolism of distal IRA was all lower than that of the primary PCI group during operation （ 0% vs 15.63 % , P 〈 O. 05 ）. Conclusion Intracoronary tirofiban injection before primary PCI in patients with STEMI is feasible and can reduce the rate of no-reflow during operation.