介入治疗联合经血栓抽吸导管冠状动脉内应用替罗非班对急性心肌梗死患者的效果

The effect of thrombus aspiration plus tirofiban on myocardial reperfusion in patients with acute myocardial infarction treated by primary percutaneous coronary intervention

目的探讨在急性ST段抬高型心肌梗死(ASTEMI)患者行急诊经皮冠状动脉介入治疗术(PCI)中进行血栓抽吸术并经抽吸导管冠状动脉内给予替罗非班的有效性和安全性。方法 选择2011年8月一2013年8月收治的ASTEMI患者57例,随机分为2组,治疗组30例(静脉应用替罗非班,PCI术中行血栓抽吸,经抽吸导管行替罗非班冠状动脉内注射),对照组27例(单纯行PCI治疗,仅静脉应用替罗非班)。观察2组术后即刻的冠状动脉TIMI分级,以及手术前后肌酸激酶同工酶(CK—MB)峰值;术后1.5 h心电图ST段回落指数(STR)≥50%比率;比较术后1周及3个月时的左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD)的变化;比较2组患者出血率及主要心血管不良事件(MACE)发生率。结果 治疗组术后即刻冠状动脉造影TIMI 3级所占比例、术后1.5 h心电图STR≥50%比率均高于对照组(P<0.05);治疗组心肌酶CK—MB达峰时间显著短于对照组(P<0.05);术后1周、3个月时2组LVEDD及LVEF均有显著差异(P<0.05)。2组患者术后大出血情况及MACE发生率比较无显著差异(P>0.05)。结论 急诊PCI术中应用血栓抽吸并经抽吸导管冠状动脉内给予替罗非班可增加心肌水平的血流灌注,减少坏死心肌数量,改善近期预后,疗效显著,安全性好。

Objective To investigate efficacy and safety of thrombectomy and given tirofiban through catheter in acute ST-segment elevation myocardial infarction（ASTEMI） patients who were underwent percutaneous coronary intervention（PCI）.Methods From August 2011 to August 2013,select 57 admitted ASTEMI patients,they were randomly divided into two groups,the treatment group with 30 patients（intravenous injected tirofiban,PCI with intraoperative thrombus aspiration,and intracoronary tirofiban injection）,the control group with 27 patients（treated with PCI alone,only intravenous injected tirofiban）.The coronary TIMI grade were observed immediately after intervention,as well as before and after intervention＇s isoenzyme of creatine kinase（CK-MB） peak;after 1.5 h ECG ST-segment resolution index（STR） ≥ 50%rate;compare postoperative one week and three months＇ changes of left ventricular ejection fraction（LVEF） and left ventricular end-diastolic diameter（LVEDD）;comparing two groups of patients bleeding rate and the incidence of main adverse cardiovascular events（MACE）.Results Coronary angiography TIMI with grade of 3＇s proportion,1.5 h after interventions electrocardiogram STR ≥50%rate in the treatment group was higher than control group（P〈0.05）;treatment group＇s time to peak cardiac enzyme CK-MB significantly lower than the control group（P〈0.05）;cardiac ultrasound examination after 1 week and 3 months of intervention showed that 2 group＇s LVEDD,LVEF were significantly different（P〈0.05）.There were no significant difference of postoperative bleeding event and MACE in the two groups（P〈0.05）.Conclusion Emergency PCI thrombus aspiration and intraoperative through the coronary give tirofiban can increase the level of myocardial perfusion and reduce the number of necrotic myocardium and improve short-term prognosis,with obvious therapeutic effect and good safety.