急性STEMI应用ThrombusterⅡ抽吸导管联合冠状动脉内注射替罗非班的疗效观察

Thrombuster Ⅱ aspiration catheter combined with intracoronary tirofiban injection in primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction

目的 观察对急性ST段抬高型心肌梗死（STEMI）患者行直接经皮冠状动脉介入（PCI）手术中应用血栓抽吸导管联合冠状动脉内注射替罗非班的疗效.方法 选择因STEMI行直接PCI并于术中应用Thrombuster Ⅱ血栓抽吸导管联合冠状动脉内推注替罗非班的患者65例作为治疗组,以基础临床资料和冠状动脉影像特征相似并单纯行直接PCI的60例患者作为对照组,观察临床疗效.结果 治疗组在TIMI 3级血流、校正TIMI帧数、术后2 h ST段回落程度、酶峰值和峰值时间以及梗死相关血管（IRA）无复流发生率均优于对照组（P＜0.05或 0.01）.治疗组术后3个月左心室射血分数（LVEF）、左心室舒张末径（LVEDd）、左心室收缩末径（LVESd）及主要不良心血管事件（MACE,包括死亡、再梗死、再次靶血管重建）的发生率少于对照组（P＜0.05）,而术后1周时两组差异无统计学意义（P ＞0.05）.结论 STEMI患者行直接PCI过程中应用血栓抽吸导管联合冠状动脉内推注替罗非班可减少无复流的发生,改善心肌再灌注水平及左心室功能.

Objective To evaluate the efficacy of thrombus aspiration catheter combined with intracoronary tirofiban injection during primary percutaneous coronary intervention （PCI） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods Sixty five patients with STEMI undergoing primary PCI and receiving thrombus aspiration catheter combined with intracoronary tirofiban injection were enrolled as study group, and those who had similar coronary angiography results and basic characteristics but only received routine primary PCI （n=60） were served as control group. The outcomes of two groups were observed and compared. Results The TIMI grade 3 flow, the TIMI frame count, resolution of sum of ST-segment elevation, peak-value of CK-MB, no-reflow in IRA after PCI, LVEF,LVEDd,LVESd and the MACE rates after 3 months in study group were superior to those in the control group （P〈0.05 or 0.01）. No significant differences were found between the two group after 1 week （P 〉0.05）.Conclusion Application of thrombus aspiration catheter combined with intracoronary tirofiban injection in patients with acute ST-segment elevation myocardial infarction is effective, which could decrease no-reflow phenomenon and improve re-perfusion and left ventricular function with better clinical outcomes in 3 months.