经抽吸导管推注替罗非班对老年人急性ST段抬高心肌梗死无复流的影响

Effect of intracoronary injection of tirofiban via aspiration catheter on myocardial no-reflow in elderly patients with acute ST-segment elevation myocardial infarction

目的 探讨在老年急性ST段抬高型心肌梗死患者中经抽吸导管推注替罗非班对无复流的疗效及对患者出血并发症的影响. 方法 连续入选65岁及以上的老年急性ST段抬高心肌梗死（STEMI）接受急诊介入治疗的患者120例,数字抽签随机分为替罗非班组和对照组各60例,两组患者均首先进行血栓抽吸治疗,替罗非班组患者在抽吸治疗后首先经抽吸导管推注替罗非班10μg/kg,后行经皮冠状动脉介入术（PCI）,对照组患者抽吸后直接行PCI,观察两组患者无复流的发生率和出血并发症的发生率. 结果 替罗非班组PCI术后无复流的发生率10.0％（6/60）,对照组25.0％（15/60）,差异有统计学意义（x2=4.68,P=0.031）.两组患者均未发生中重度出血并发症,替罗非班组轻度出血16例（26.7％）,对照组13例（21.7％）,两组比较差异无统计学意义（x2=0.19,P=0.522）. 结论 经抽吸导管推注替罗非班可降低老年急性STEMI患者无复流的发生率,同时不增加出血并发症.

Objective To evaluate the effect of early intracoronary injection of tirofiban via aspiration catheter on myocardial no-reflow in elderly patients with acute ST-segment elevation myocardial infarction （STEMI）.Methods 120 consecutive patients over 65 years old with AMI undergoing primary percutaneous coronary intervention （PCI） were randomized into two groups.In tirofiban group （n=60）,thrombus aspiration and intracoronary tirofiban bolus （10 μg/kg prior to the first balloon inflation） via aspiration catheter were performed.In control group （n=60）,thrombus aspiration was followed by primary PCI.The incidence of no-reflow and bleeding were assessed in the two groups.Results The moderate to severe bleeding （TIMI bleeding criteria） did not occur in the two groups,there＆#39;s no significant difference between two groups in the incidence of minor bleeding [26.7%（16 cases） vs.21.7% （13 cases）,x2 =0.19,P=0.522].The incidence of myocardial noreflow was significantly lower in tirofiban group than in the control group [10.0% （6/60） vs.25.0% （15/60）,x2 =4.68,P=0.031].Conclusions The intracoronary injection of tirofiban via aspiration catheter may significantly reduce the incidence of myocardial no-reflow in patients with STEMI without increasing bleeding complications.