血栓抽吸联合替罗非班和维拉帕米预防急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗无复流的临床疗效研究

Efficacy of Thrombus Aspiration Combined with Tirofiban and Verapamil in Prevention of No-reflow in Patients with Acute ST-segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

目的观察血栓抽吸联合冠状动脉内推注替罗非班、维拉帕米预防急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗(PCI)无复流的疗效及安全性。方法将我院收治的65例急性ST段抬高型心肌梗死患者随机分为联合治疗组34例和标准PCI组31例。联合治疗组:在Diver CE导管抽吸后经冠状动脉直接推注维拉帕米和替罗非班,再根据具体情况予以球囊扩张和/或支架术;标准PCI组:术前静脉推注替罗非班,然后静脉泵入替罗非班,维持24～48 h,术中如出现"慢血流"或"无复流"使用维拉帕米,予以球囊扩张和/或支架术。观察住院期间出血并发症及主要心血管事件。结果住院期间联合治疗组恶性心律失常和心脏破裂发生率均低于标准PCI组(P<0.05);两组均未发生严重出血并发症。结论血栓抽吸联合冠状动脉内推注替罗非班、维拉帕米预防急性ST段抬高型心肌梗死患者直接PCI无复流有效、安全。

Objective To observe the safety and efficacy of thrombus aspiration combined with intracoronary bolus tirofiban and verapamil in preventing no - reflow in patients with acute ST - segment elevation myocardial infarction undergoing primary percutaneous coronary intervention （PCI）. Methods 65 patients admitted to our hospital with acute ST- segment ele- vation myocardial infarction were randomly divided into combined treatment group of 34 cases and standard PCI group of 31 cases. Patients in combined treatment group were injected verapamil and tirofiban through coronary after thrombus aspiration by device Diver CE, and then given I balloon dilatation and/or stenting depending on the patients＇condition; Patients in standard PCI group were injected tirofiban through venous before PCI, and then tirofiban infused, maintain for 24 -48 h, verapamil was given when slow flow ＂ or＂ no - reflow occurred during the operation, and I balloon dilatation and/or stenting after. The incidence of major adverse cardiovascular events and hemorrhagic complications of the two groups were observed during hospitalization. Resuits During hospitalization, malignant arrhythmias and cardiac rupture in combined therapy group were lower than those of standard PCI group （P 〈 0. 05）, and no hemorrhagic complications occurred. Conclusion Thrombus aspiration combined with tirofiban and verapamil in preventing no - reflow in patients with acute ST - segment elevation myocardial infarction undergoing primary PCI is safe and effective.