经不同途径冠脉内应用异搏定对急诊冠脉介入治疗术中无复流现象的疗效比较

Efficacy Comparison of Different Routes of Intracoronary Verapamil on No-Reflow Phenomenon during Emergency Percutaneous Coronary Intervention

目的:比较经两种不同途径冠状内应用异博定对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者在急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术中无复流现象的疗效。方法:2009年1月—2012年12月于急诊PCI术中出现无复流现象后接受冠脉内应用异搏定的STEMI患者141例,根据异搏定给药途径的不同分为指引导管组(n=67)和选择性导管组(n=74),比较两组术后冠脉血流灌注水平、心电图ST段回落幅度、左室射血分数(left ventricular ejection fraction,LVEF)以及术后30 d主要不良心血管事件发生率。结果:两组患者的一般资料、冠脉内用药剂量差异均无统计学意义(P>0.05);选择性导管组用药后校正的TIMI血流帧数(cTFC)明显低于指引导管组(P<0.05);选择性导管组恢复TIMI-3级血流患者比例明显高于指引导管组(P<0.05);选择性导管组获得ST段完全回落比例明显高于指引导管组(P<0.05);两组LVEF和术后30 d主要不良心血管事件发生率差异均无统计学意义(P>0.05)。结论:经选择性导管冠脉内应用异搏定治疗STEMI患者急诊PCI术中无复流现象的疗效明显优于经指引导管给药。

Objective：To explore the efficacy difference of two different routes of intracoronary verapamil on no-reflow phe-nomenon during primary percutaneous coronary intervention （PCI） in patients with acute ST-segment elevation myocardial in-farction （STEMI） .Methods ：From January 2009 to December 2012 ,141 STEMI patients with no-reflow phenomenon during e-mergency PCI who received the manual intracoronary bolus infusion of verapamil were selected .According to the routes of in-tracoronary verapamil ,patients were divided into guiding catheter group （n=67） and selective catheter group （n=74） .The coronary perfusion level ,the ECG ST-segment resolution ,left ventricular ejection fraction （LVEF） and major adverse cardiac events in 30 days post-PCI were compared .Results：There were no statistically significant differences in general datum of the two groups and the average dose of intracoronary infusion verapamil （P〉0 .05） .The level of cTFC in the the selective catheter group was significantly lower than that in the guiding catheter group （P〈0 .05） .More patients restored the TIMI-3 flow after drug infusion in selective catheter group than guiding catheter group （P〈0 .05） .The proportion of complete ST-segment reso-lution after PCI in the selective catheter group was significantly higher than that in guiding catheter group （P〈0 .05） .No sta-tistically significant differences were found in LVEF and incidence of major adverse cardiac events during 30 days between the two groups （both P〉0 .05） .Conclusions ：The intracoronary verapamil through selective catheter can reverse no-reflow phe-nomenon more effectively than through guiding catheter during emegency PCI for STEMI .