硝酸甘油联合盐酸替罗非班治疗经皮冠状动脉介入术发生无复流现象时的临床疗效研究

Research on the Clinical Outcomes of Nitroglyceride and Tirofiban Hydrochloride in No-reflow Patients after PCI

目的探讨硝酸甘油注射液联合GPⅡb/Ⅲa受体拮抗剂盐酸替罗非班注射液对治疗经皮冠状动脉介入术(percutaneous coronary intervention,PCI)过程中发生无复流时对TIMI血流的影响。方法 2005年1月至2011年10月我院收治的PCI时发生无复流病例40例,随机分成2组。A组:发生无复流时即刻冠脉内注射硝酸甘油注射液200～300μg,观察TIMI血流恢复情况,如无效再给予盐酸替罗非班注射液5μg/kg冠脉内注入(设为A+B组)。B组:发生无复流时即刻冠脉内注射盐酸替罗非班注射液5μg/kg,观察TIMI血流恢复情况,如无效再给予硝酸甘油注射液200～300μg冠脉内注入(设为B+A组)。结果血流恢复情况B组疗效优于A组(P<0.01),A+B组与B+A组比较无明显差异(P>0.05),但联合用药(A+B组或B+A组)两组患者均恢复TIMIⅢ级前向血流,联合用药对TIMI血流恢复情况明显优于单用硝酸甘油注射液(A组)或盐酸替罗非班(B组)(P<0.05)。结论 PCI术中发生无复流时即刻冠脉内注入硝酸甘油注射液联合替罗非班注射液后明显恢复TIMI前向血流,明显减少不良心血事件(MACE)的发生,提高心肌灌注,并改善临床预后。

Objective To evaluate the effects of nitroglyceride and tirofiban hydrochloride,a platelet GPⅡb/Ⅲa receptor antagonist,on the TIMI blood flow for no-reflow patients after percutaneous coronary intervention（PCI）.Methods From January 2005 to October 2011,40 patients in our hospital with the symptoms of no-reflow after PCI,were randomly divided into two groups.Group A： took an intracoronary injection of nitroglyceride of 200~300μg immediately when no-reflow,and if it was not effective,took an intracoronary injection of tirofiban 5μg/kg instantly（named as Group A＋B）.Group B： took an intracoronary injection of tirofiban 5μg/kg immediately when no-reflow,and if it was not effective,took an intracoronary injection of nitroglyceride 200~300μg instantly（named as Group B＋A）.Results The reflow ratio in Group B was better than Group A（P〈0.01）.Both of Group A＋B and Group B＋A could restore the TIMIⅢ forward flow.And each of the combined therapy got better blood flow than the used of the drug alone（P〉0.05）.Conclusion Combined intracoronary injection of nitroglyceride and tirofiban on no-reflow patients after PCI can obviously improve the TIMI flow and reduce the occurrence rate of adverse cardiovascular events（MACE）,thus may be effective for the myocardial reperfusion,cardiac function and clinical outcomes.