前列地尔联合替罗非班逆转急诊冠状动脉介入术无复流的研究

Study on no-reflow reversion effect of alprostadil plus tirofiban before acute percutaneous coronary intervention

目的观察在急诊经皮冠状动脉介入(PCI)术前联合应用血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班和前列地尔后在防治术中出现无复流的疗效。方法将符合急性心肌梗塞入选标准的患者70例,随机分为干预组(n=35)和对照组(n=35)。进行PCI术前,两组均常规给予氯吡格雷600 mg、拜阿司匹林300 mg,两组均在术前给予替罗非班,而干预组在围手术期还使用前列地尔。结果两组在术后发生TIMI 3级血流的无明显差异(P>0.05),但在TMP方面,干预组较对照组有明显改善(P<0.05);1周内两组射血分数相似(P>0.05)。结论在急诊PCI术前替罗非班联合应用前列地尔能够改善心肌的微循环灌注,进一步减少无复流的发生。

Objective To observe the effect of alprostadil combined with tirofiban （platelet glyeoprotein Ⅱb/ⅡA-reeeptor blockers） before acute percutaneous coronary intervention （PCI） in prevention of no-re/low during operation. Methods A total of 70 acute myocardial infarction patients were randomized into trial group and control group （n = 35 ）. Before operation, all patients were given 300 mg of aspirin and 600 mg of clopidogrel conventionally. Both groups were administrated with tirofiban, and the trial group used alprostadil in addition. Results There was no postoperative difference in TIMI grade 3 between the two groups, but TIMI myoeardial perfusion（TMP） grade 3 improved more significantly in the trial group than in the control group （P 〈 0.05）. Left ventrieular ejection fraction （LVEF） was similar within one week between the two groups. Conclusion Using alprostadil combined with tirofiban before emergency PCI can further improve the myoeardial perfusion, and lower the incidence rate of no-reflow.