冠状动脉内注射替罗非班对急性ST段抬高型心肌梗死患者介入治疗后无复流现象的影响

Influence of intracoronary tirofihan on no-reflow phenomenon after percutaneous coro- nary intervention in patients with acute ST segment elevation myocardial infarction

目的评价冠状动脉内注射替罗非班对急性ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉介入治疗（PCI）后无复流发生率的影响。方法将120例STEMI患者分为替罗非班组（替罗非班＋直接PCI，60例）和对照组（直接PCI，60例）。PCI术中根据TIMI血流分级、TIMI计帧法（cTFC）评价冠状动脉血流。术后24h进行实时心肌声学造影检查，计算心肌灌注缺损计分指数（CSI）及室壁运动计分指数（WMSI）。分析术后1h2组患者心电图sT段偏移总和比值（sumSTR）的变化。结果替罗非班组TIM13级血流显著多于对照组（P〈0．05），而cTFC显著低于对照组（P〈0．05）；替罗非班组与对照组相比CSI（1．23±0．33．1．38±0．43，P〈0．05），WMSI（1．52±0．39：1．70±0．38；P〈0．05）均显著降低；与对照组比较，替罗非班组术后1hsumSTR〉70％比例更高（P〈0．05）。结论冠状动脉内注射替罗非班能改善STEMI患者PCI术后心肌血流，防止无复流的发生。

Objective To evaluate the influence of intracoronary tirofiban on the incidence of no reflow after percutaneous coronary intervention （ PCI ） in patients with acute ST segment elevation myocardial infarction （ STEMI ）. Methods 120 STEMI patients were divided into tirofiban group （ tirofiban and direct PCI, n = 60 ） and control group （ direct PCI, n = 60 ）. During PCI, coronary flow was evaluated according to TIMI flow grading and corrected TIMI frame count （ cTFC ）. The changes in sum ST segment resolution （ sumSTR ） were compared one hour after PCI; myocardial perfusion defect score index （ CSI ） and wall motion score index （ WMSI ） were computed 24 hours after PCI according to myocardial contrast echocardiography （ MCE ）. Results The blood flow of TIMI grade 3 was greater in tirofiban group than in the control group （ P 〈 0.05 ） and cTFC was significantly lower in tirofiban group than in the control group （ P〈 0.01 ）;, CSI and WMSI were was significantly lower in tirofiban group than in the control group （ 1.23 ± 0.33 vs. 1.38± 0.43, 1.52 ±0.39 vs. 1.70±0.38; P〈 0.05 ）; the ratio of sumSTR 〉 70% was significantly higher in the tirofiban group than in the control group （ P 〈 0.05 ）. Conclusions Intracoronary tirofiban can improve myocardial blood flow in STEMI patients after PCI and can prevent the occurrence of no reflow.