经微导管注射与经导引导管注射替罗非班对经皮冠状动脉介入术中无复流的疗效观察

Efficacy of Tirofiban from Microcatheter and Guiding Catheter Applied No-reflow of Percutaneous Coronary Intervention

目的对比观察经微导管注射替罗非班与经导引导管注射替罗非班处理经皮冠状动脉介入(percutaneous coronaryintervention,PC)I术中无复流现象的临床效果.方法 PCI治疗术中出现无复流现象的患者40例,随机平均分为微导管组(n=20)和导引导管组(n=20).出现无复流后,微导管组将微导管置入靶血管远端,通过微导管注射替罗非班,导引导管组则直接通过导引导管冠脉内注射替罗非班.统计2组PCI手术结束时血流达到TIMI-3级和心肌组织灌注达到TMPG-3级的例数,出现无复流现象到首次开始注射药物的时间,血流恢复TIMI-3级的时间,心肌组织灌注恢复TMPG-3级的时间,PCI手术时间,X线暴露时间和术后1周左室射血分数,进行统计分析.结果微导管组与导引导管组比较,在手术结束时冠脉血流达到TIMI-3级的例数差异统计学意义(19例vs 14例,P>0.05),但微导管组心肌组织灌注达到TMPG-3级的例数显著高于导引导管组(19例vs 12例,P<0.05).从出现无复流现象到首次注射药物所需要的时间微导管组多于导引导管组(1.9±0.5)min vs(0.5±0.3)min,P<0.05.微导管组从出现无复流现象到冠脉恢复TIMI-3级血流(5.7±2.2)min vs(9.1±3.0)min,P<0.05,心肌组织灌注恢复TMPG-3级(5.9±2.7)min vs(12.5±3.1)min,P<0.01,所需时间显著小于导引导管组.2组PCI手术时间(46.3±17.6)min vs(47.8±16.3)min,P>0.05,X线曝光时间(14.1±4.1)min vs(12.6±5.3)min,P>0.05,术后1周LVEF(49.2%±6.7)%vs(47.3±8.1)%,差异无统计学意义(P>0.05).结论在PCI出现无复流现象后,置入微导管于远端血管床注射替罗非班的方法,可以比直接冠脉内注射替罗非班更加快速逆转无复流.

Objective To compare and observe the clinical efficacy of tirofiban from microcatheter and guiding catheter on the no-reflow during percutaneous coronary intervention （PCI） . Methods Forty patients with acute myocardial infarction （AMI） who had no-reflow during emergency PCI were randomly divided into the microcatheter group （n =20） and the guiding catheter group （n =20） . Intro-microcatheter tirofiban to distal vascular bed of target vessel were administered in the patients of microcatheter group and tirofiban were injected into coronary from guiding-catheter in the patients of guiding-catheter group when no-reflow phenomenon occurred. The important indexes were detected and compared between the two groups, including the cases of thrombolysis in myocardial infarction-3 （TIMI-3） flow grade and TIMI myocardial perfusion-3 （TMPG-3） grade at the endpoint of PCI, the time from no-reflow occurred to the first drug injection, the time from no-reflow occurred to restored TIMI-3 blood flow and TMPG-3 perfusion, the times of PCI and X-ray exposure and left ventricle ejection fraction （LVEF） after one week. Results The number of cases of TIMI-3 blood flow at the endpoint of PCI had no significant difference in the two groups （ 19 cases vs 14 cases, P 〉0.05） , but the number of TMPG-3 perfusion in