抗血小板药物对冠心病患者介入术后无复流发生率的影响

Effects of antiplatelet drugs on the incidence of no-reflow after percutaneous coronary intervention in patients with coronary heart disease

目的探讨抗血小板药物对冠心病患者介入术后无复流发生率和术后主要心脑血管不良事件发生率的影响。方法选取20lO年1月至2011年9月84例冠心病患者行冠状动脉血管介入治疗并发生无复流现象的患者，采用随机数字表法分为观察组和对照组各42例。观察组患者于术后发现无复流或慢复流时经引导管冠状动脉注射盐酸替罗非班，如无效，则再经指引导管注射替罗非班，并持续微量泵泵人24h。对照组则在出现无复流或慢复流时经引导管冠状动脉注射维拉帕米，如无效则再指引导管给予维拉帕米。结果观察组经冠状动脉造影用药后首次和末次心肌梗死溶栓血流分级（TIMI）3级的患者26例（61．9％）、35例（83．3％），多于对照组17例（40．5％）和23例（54．8％），差异具有统计学意义（y。值为3．86、8．02，均P〈0．05），且用药后首次冠状动脉造影显示观察组患者TIMI计帧法（TFc）低于对照组（t=一3．44，P〈0．05），用药后末次TFC差异进一步增大数值（t=一12．41，P〈0．05）。观察组和对照组患者用药后首次和末次TMPG3级率分别为57．1％（24例）和31.0％（13例）、73．8％（3l例）和47．6％（20例），组间比较差异有统计学意义（X2值为5．84、6．04，均P〈0．05）。随访60d时，观察组患者和对照组患者的终点事件发生率分别为23．8％（10例）和52．3％（12例），差异有统计学意义（X2=7．27，P〈0．01）。同时无复流的易发因素包括年龄、急性心肌梗死、糖尿病、高脂血症及高血压。结论盐酸替罗非班可有效减少冠心病患者介入术后无复流发生率，使用安全，值得推广使用。

Objective To observe the effects of antiplatelet drugs on the incidence of no-reflow, main adverse cardiovascular and cerebrovascular events （MACCE） after percutaneous coronary intervention （PCI） in patients with coronary heart disease （CHD）. Methods From January 2010 to February 2011, a total of 84 CHD patients with no-reflow after PCI were selected and randomly divided into observed group and control group （n=42 each group）. Patients with no/slow-reflow in observed group were injected with tirofiban through coronary artery with a guiding catheter. If invalid, patients were injected with tirofiban by catheterization again with a micro-pump continuous pumping for 24 h. Patients with no/slow-reflow in control group were injected with verapamil by catheterization. If invalid, patients were injected with verapamil by catheterization again. Results The numbers of patients with Tbrombolysis in Myocardial Infarction （TIMI） 3 in the first and last angiography after drug administration were much more in observed group than in control group [26 cases （61.9%） vs. 17 cases （40.5%）, 35 cases （83.3%） vs. 23 cases （54.8%）, respectively, X2 =3.86, 8.02, both P〈0.05]. The first TIMI frame count （TFC） after drug administration was significantly lower in observed group than in control group, and the difference between groups became larger in the last TFC （t=- 3.44, --12.41, both P〈0.05）. The number of patients with TIMI myocardial perfusion grade （TMPG） 3 in the first and last angiography after drug administration were much more in observed group than in control group [24 cases （57.1%） vs. 13 cases （31.0%）, 31 cases （73.8%） vs. 20 cases （47.6%）, respectively,X2 =5.84, 6.04, both P〈0.05]. After 60 days of follow-up, therewas a significant difference in the incidence of endpoint events between observed and control group [23.8% （10 cases） vs. 52.3% （12 cases）, X2 = 7.27, P〈0. 01]. The predisposing factors of no- reflow were age, acute myocardial infarction （AMI）, diabetes, hyperlipidemia and hypertension. Conclusions Tirofiban can effectively and safely reduce the incidence of no-reflow after percutaneous coronary intervention in patients with CHD.