急性下壁心肌梗死应用Diver CE血栓抽吸导管联合替罗非班的临床疗效研究

Study on the curative effect of Diver CE with tirofiban for acute inferior myocardial infarction patients

目的前瞻性随机比较急性下壁心肌梗死（AIMI）患者施行急诊冠状动脉介入治疗（PCI）前应用Diver CE血栓抽吸导管联合替罗非班与单独应用Diver CE抽吸导管的临床疗效。方法采用随机方法比较发病〈12h、TIMI血流0～1级AIMI患者施行直接PCI前Diver CE血栓抽吸导管联合替罗非班的有效性。观察PCI后ST段回落程度、心肌染色血流分级、随访30d左心室射血分数（EF）、主要心血管事件（MACE）发生率。结果62例患者入选本研究。Diver CE抽吸导管联合替罗非班（联合组）和单独应用Diver CE抽吸导管（常规组）患者的年龄、男性、糖尿病、陈旧性心肌梗死、梗死前心绞痛、症状发作到直接PCI时间等基线资料均匹配。两组ST段回落率[（69．4±12．3）％和（52．5±11．8）％，P〈0．05]、TIMI血流3级获得率（93％和88％，P〈0．05）和心肌TMP3级获得率（72．0％和58．0％，P〈0．01）比较差异均有统计学意义。术后30d，两组EF[（62．8±7．4）和（52．6±9．7），P〈0．05]、MACE发生率（6．7％和15．7％，P〈0．05）比较差异均有统计学意义。结论血栓负荷较重的AIMI患者在PCI前应用Diver CE装置去除血栓联合冠状动脉内注入替罗非班，可明显改善心肌灌注及近期预后。

Objective In this randomized prospective study, to compare the curative effect between Diver CE device plus tirofiban and Diver CE alone before percutaneous coronary intervention （PCI） in the patients with acute inferior myocardial infarction. Methods A total of 62 patients （31 in Diver CE and tirofiban group and 31 in routine group ） were studied. The ST - segment resolution, myocardial blush grade, 30 - day left ventricle ejection fraction （LVEF） after PCI, MACE rates were measured in the patients. Results Basic characteristics were similar between two groups： age [ （58 ±15.2） years vs （59 ± 14. 6） years], males（83% vs 87% ）,diabetes （35% vs 32% ）, old myocardial infarction （ 9% vs 6% ） , preinfarctional angina pectoris （ 13% vs 13% ） , onset - to - angiogram [ （ 6. 1 ±2. 9 ） h vs （ 5.9 ± 3.0 ） h]. TIMI flow grade 3 9 93% vs 88% ,P 〈 0.05 ） and percentage of TMP grade 3 of IRAs（72.0% vs 58.0% ,P 〈0. 01 ） were higher in combined group. There were higher ST segment resolution in the combined group compared with routine group after PCI [ （69.4 ±12. 3）% vs （ 52. 5 ± 11.8 } %, P 〈 0. 05 ]. After 30 days, left ventricle ejeetive fraction was significantly higher in the combined group than in the routine group [ （ 62. 8 ±7.4 ） vs （ 52. 6 ± 9.7 ） , P 〈 0.05 ], and there were significant differences between the two groups in the incidence of MACE （ 6. 7% vs 15.7% , P 〈 0. 05）. Conclusion Diver CE device with tirofiban for acute inferior myocardial patients with PCI improves microvaseular perfusion and short - term prognosis.