血栓抽吸和替罗非班在急诊冠脉介入治疗中的临床研究

Application of thrombus aspiration combined with tirofiban in percutaneous coronary intervention

摘要目的在急性ST段抬高的心肌梗塞急诊介入治疗中，评价血栓抽吸和梗塞相关动脉内使用替罗非班与单纯血栓抽吸的安全性和有效性。方法将绵阳市中心医院2011—2013年的急性ST段抬高的心肌梗塞并行急诊介入治疗的患者230例，随机分为血栓抽吸和梗塞相关动脉内使用替罗非班组和单纯血栓抽吸组。记录如下数据：介入治疗后即刻TIMI（Thromblysisinmyocardial infacrtion，TIMI）等级、90min内sT段回落的百分比，cTnI峰值，介入治疗术后7d和6个月左室射血分数以及严重出血发生。结果两组在年龄、性别、高血压、糖尿病、吸烟等临床基本资料无显著差异，血栓抽吸和梗塞相关动脉内使用替罗非班组较单纯血栓抽吸组具有更高的TIMI3级血流和sT段完全回落到基线的比例，更低的cTnI峰值而左室收缩功能得到更好的保存；两组在住院期间严重出血发生率无显著性差异。结论在急性ST段抬高的心肌梗塞患者的急诊介入治疗中，血栓抽吸和梗塞相关动脉内使用替罗非班较单纯血栓抽吸能更好的改善心肌灌注，减少心肌坏死从而改善患者心功能，同时并不增加出血风险。

objective To compare the efficiency and safety between thrombus aspiration combined with intra-infarct-related artery administration of tirofiban and thrombus aspiration alone in treatment of patients with ST-elevation myocardial infarction（STEMI）. Methods The 230 patients with STEMI from 2011 to 2013 were randomly divided into two groups： thrombus aspiration plus intra-infarct-related artery administration of tirofiban and thrombus aspiration alone. The of results thrombolysis in myocardial infarction （TIM1） flow immediately after angioplasty, ST segment elevation resolution（〉50%） at 90 minutes after angioplasty, the peak troponin I and the left ventricular ejection fraction （LVEF） of the 7th day and the 6tii month after PCI as well as any bleeding events were noticed and analyzed. Results There was no significant difference in baseline characteristics of the two groups. The TIMI 3 flow rate, ST-segment resolution rate and LVEF were significandy higher in the cases of treated with thrombus aspiration plus intra-infarct-related artery administration of tirofiban than those treated with thrombus aspiration alone. Compared to the cases treated with thrombus aspiration alone, the peak level of TnI was lower in the cases treated with thrombus aspiration plus intra-infarct-related artery administration of tirofiban. There was no significant difference in bleeding events between the two groups. Conclusion Thrombus aspiration plus intra-infarct-related artery administration of tirofiban may improve myocardial perfusion as well as LVEF and the occurrence of myocardial infarction reduce.