经抽吸导管早期应用维拉帕米对急性心肌梗死再灌注无复流的疗效观察

Beneficial effect of early administration of intracoronary verapamil via thrombus-aspirating device in patients with acute myocardial infarction with no-reflow

目的探讨经抽吸导管冠状动脉内早期给予维拉帕米治疗急性ST段抬高心肌梗死(AMI)患者直接经皮冠状动脉介入治疗(P-PCI)术中无复流现象的疗效。方法 168例AMI患者进行直接PCI术,先行抽吸导管抽吸血栓后,随机分成两组,A组(n=86):经抽吸导管向靶病变远端给予维拉帕米100～200μg/次,总量不超过600μg;B组(n=82):支架植入发生无复流现象后再通过指引导管向冠状动脉内给予维拉帕米100～200μg/次,总量不超过600μg。造影评价给药前后冠状动脉血流心肌梗死溶栓试验(TIMI)分级和TI-MI心肌组织灌注分级(TMPG),评价术后1 h心电图ST段下降情况。结果术后A组TIMI 3级血流比例明显高于B组(91.86%vs.80.49%,P<0.05);术后A组TMPG 3级比例明显高于B组(88.37%vs.75.61%,P<0.05);A组心电图ST段迅速下降比例明显高于B组(80.23%vs.65.85%,P<0.05)。结论早期经抽吸导管向靶病变远端给予维拉帕米较传统方法进一步减少了AMI患者P-PCI术中无复流现象的发生。

Objective To evaluate the effects of early administration of intracoronary verapamil via thrombus-aspirating device on no-reflow phenomenon during primary percutaneous coronary intervention（P-PCI） in patients with acute ST elevation myocardial infarction.Methods Consecutive 168 patients with ST elevation acute myocardial infarction treated with P-PCI were enrolled,thrombotic clot was aspired before stent was implanted via thrombus-aspirating device first.Patients were divided into two groups randomly.Group A（n=86）：the first single bolus of verapamil of 100 to 200 μg was administered to distal end of target lession via thrombus-aspirating device,the total amount was less than 600 μg.Group B（n=82）：the first single bolus of intracoronary verapamil of 100 to 200 μg was administered via guiding catheter after no-flow phenomenon,the total amount was less than 600 μg.Thrombolysis in myocardial infarction（TIMI）flow grade,TIMI myocardial perfusion grade（TMPG）before and after administration and resolution of ST segment elevation an hour after P-PCI were assessed.Results After PCI,compared with group B,group A showed significantly higher TIMI 3 flow degree：91.86% vs.80.49%,P〈0.05;TMPG 3 was found to have higher rate in group A：88.37% vs.75.61%,P〈0.05;group A showed significantly higher rapid resolution of ST segment elevation rate：80.23% vs.65.85%,P〈0.05.Conclusions Compared with conventional process,early administration of verapamil to distal end of target lession via thrombus-aspirating device could decrease the no-flow phenomenon during P-PCI in patients with acute ST elevation myocardial infarction.