替罗非班联合冠脉内血栓导管抽吸对急诊ST段抬高心肌梗死患者PCI术血运重建的影响

The Influence of Tirofiban Combined with Thrombus-aspiration on Revascularization during PCI in ST-segment Elevation Myocardial Infarction

目的探讨替罗非班联合冠脉内血栓导管抽吸对急诊ST段抬高心肌梗死(STEMI)患者标准经皮冠状动脉介入治疗(PCI)术血运重建的影响。方法 98例STEMI患者随机分为PCI+血栓抽吸+替罗非班组(A组),PCI+替罗非班组(B组)。观察两组患者血管再通时即刻的血流血管心肌梗死溶栓(TIMI)分级、TIMI心肌灌注(TMPG)分级、术后2h心电图ST段回落大于50%的发生率、心肌磷酸激酶同工酶(CK-MB)峰值、CK-MB峰值时间,术后2h胸痛缓解率再灌注心律失常发生率。结果 A组心肌灌注明显增加,TIMI血流及TMPG血流明显改善,术后2h心电图ST段回落大于50%的发生率、CK-MB峰值、CK-MB峰值时间,术后2h内胸痛缓解率及再灌注心律失常发生率优于对照组。结论血栓抽吸与替罗非班联合治疗可改善急性ST段抬高性心肌梗死患者冠脉内血栓病变的血栓负荷、冠状动脉血流、心肌灌注,改善患者预后。

Objective To explore the effect of platelet glycoprotein（GP） Ⅱ b/Ⅲ a receptor antagonists tirofiban combined with thrombus- aspiration during percutaneous coronary intervention （PCI） on revascularization in ST- segment elevation myocardial infarction （STEMI）. Methods Ninety - eight patients with STEMI were arranged into 2 groups： Group A treated by PCI plus thrombus - aspiration and tirofiban, group B treated by PCI plus tirofiban. The rate of post - procedure thrombolysis in myocardial infarction （TIMI） frame counts, TIMI myocardial perfusion grade （TMPG）, 50 % ST -segment elevation resolution （STR）, creatine kinase isoenzyme MB （CK - MB） peak value and time,remission rate of chest pain,and reperfusion arrhythmia were compared. Results Comparing with the group B, myocardial perfusion, TIMI, and TMPG were better in group A. There were higher rate of 50% STR, remission of chest pain and reperfusion arrhythmia in 2 hours in group A than that in group B. Anticipation of CK - MB peak value and time were more obvious in group A than that in group B. Conclusion The thrombus - aspiration with GP Ⅱ b/Ⅲ a antagonists can reduce thrombus burden,increase coronary blood, improve myocardial microvascular reperfusion, and improve prognosis in patients with STEMI during PCI.