冠状动脉内注射替罗非班对急性心肌梗死患者介入治疗中无复流现象的疗效研究

Clinical study of intracoronary injections of tirofiban in acute myocardial infarction patients with no reflow phenomenon after percutaneous coronary intervention

目的:观察冠状动脉内注射替罗非班对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术中无复流现象的疗效。方法:替罗非班组为2005-01-2009-09AMI患者行PCI术中出现无复流现象后给予冠状动脉内注入替罗非班的患者46例;对照组为同期AMI患者行PCI术中出现无复流现象后给予冠状动脉内注入维拉帕米患者49例。观察2组患者注射药物后首次和PCI手术结束前末次冠状动脉造影图像,评估心肌梗死溶栓试验(TIMI)血流分级、矫正的TIMI帧数(cTFC)、TIMI心肌组织灌注分级(TMPG)。结果:冠状动脉内注射药物后首次及PCI结束前末次冠状动脉造影均显示:替罗非班组TIMI3级血流比例明显高于对照组,分别为(63.0%比40.8%,P<0.05)和(78.3%比49.0%,P<0.01);替罗非班组cTFC帧数明显少于对照组,分别为(38.6±7.1比49.3±9.3,P<0.01)(28.5±6.4比40.4±8.7,P<0.01);替罗非班组TMPG3级血流比例明显高于对照组,分别为(54.3%比32.7%,P<0.05)和(71.7%比46.9%,P<0.05)。结论:冠状动脉内注射替罗非班可以增加AMI患者PCI术中发生无复流现象后冠状动脉血流和心肌组织灌注。

Objective：To observe the clinical effect of intracoronary injections of tirofiban in patients with acute myocardial infarction（AMI） that had no reflow phenomenon during percutaneous coronary intervention（PCI）.Method：From January 2005 to September 2009,45 patients with AMI who had no reflow phenomenon during PCI were enrolled for intracoronary injections of tirofiban treatment as study groups,49 patients with AMI during the same time who had no reflow phenomenon during PCI were enrolled for intracoronary injections of verapamil treatment as control.Thrombolysis in myocardial infarction（TIMI） flow grade,corrected TIMI frame count（cTFC） and TIMI myocardial perfusion grade（TMPG） were assessed from the first contrastographic picture after drug administration and the last contrastographic picture at the end of PCI.Result：Compared with control group,Tirofiban treated group showed significantly higher TIMI3 flow degree in the first contrastographic picture after administeration（63.0% vs 40.8%,P0.05） and in the last contrastographic picture of after PCI（78.3% vs 49.0%,P0.01）.cTFC was significantly decresased in tirofiban treated group in the first contrastographic picture after administration（38.6±7.1 vs 49.3±9.3,P0.01） and in the last contrastographic picture post PCI（28.5±6.4 vs 40.4±8.7,P0.01） as compared to control group.TMPG 3 was found to have higher rate in the tirofiban treated group in the first contrastographic picture after administration（54.3% vs 32.7%,P0.05） and in the last contrastographic picture post PCI（71.7% vs 46.9%,P0.05）.Conclusion：Intracoronary injections of tirofiban to AMI patients with no reflow phenomenon during PCI could improve acoronary arterial blood flow and myocardial tissue perfusion.These results indicate that tirofiban is an effective treatment to AMI patients with no reflow phenomenon during PCI.