腺苷联合替罗非班应用于冠状动脉介入患者的效果分析

The efficacy and security of adenosine combined tirofiban on patients with percutaneous coronary intervention

目的 探讨急性ST段抬高心肌梗死（STEMI）患者直接经皮冠状动脉介入治疗（PCI）中冠状动脉内替罗非班联合高剂量腺苷的治疗效果.方法 采用前瞻性、双盲、随机研究,根据随机数字表将接受PCI的88例STEMI患者分为观察组（44例）和对照组（44例）.两组均将10μg/kg替罗非班经抽吸导管于罪犯病变远端推注3 min,同时持续静脉滴注0.15 μg/（kg＆#183; min） 24 h.在此基础上,观察组患者的冠状动脉内推注腺苷（2mg,10 ml0.9％氯化钠）2次,对照组推注10 ml 0.9％氯化钠2次.评估术后两组患者的冠状动脉造影、心电图指标,随访术后患者的心肌Blush分级（MBG）、心肌梗死溶栓试验（TIMI）血流分级、校正的TIMI帧数（CTFC）、总ST段抬高回落（STR）、12个月主要不良心脏事件 （MACE）、腺苷引发的不良反应.结果 两组患者的术后TIMI血流分级、ST抬高完全回落比例比较差异均无统计学意义（P均＞0.05）;观察组CTFC[（21.9±3.7）帧与（24.4±4.9）帧,t=2.701,P＜0.01]、MBG 3级的例数分布（24/44与14/44,x^2=4.632、P＜0.05）与对照组比较差异均有统计学意义.两组患者随访1、12个月时的死亡人数、MACE、靶血管血运重建以及NYHA分级比较差异均无统计学意义（P均＞0.05）;观察组的血压下降≥10mm Hg（15.9％与2.3％,x^2=4.950,P=0.026）、新发二度以及以上房室传导阻滞（20.5％与15.9％,x^2=7.221,P=0.007）的比例显著高于对照组,差异均有统计学意义;腺苷引发的不良反应均为一过性.结论 在STEMI患者治疗中,冠状动脉内替罗非班联合高剂量腺苷的应用对其PCI术后的心肌灌注有改善作用.

Objective To compare the egicacy and security of intracoronary administration of tirofiban combined high-dose adenosine during percutaneous coronary intervention （PCI） in patients with acute myocardial infarction （STEMI）.Methods Eighty-eight cases with STEMI were randomly divided into observation group（44 cases） who were accepted 2 times intracoronary adenosine（2 mg,10 ml 0.9% NaCl）,and control group（44 cases） who were afforded only 10 ml 0.9% NaCl by prospective,double-blind,and random study.The two groups were received10 g/kg tirofiban after aspiration catheter in the culprit lesion distal bolus injection of 3 rain,at the same time,continuous infusion of 0.15 g/（kg ＆#183; min） for 24 h.The postoperative coronary arteriography and electrocardiogram were evaluated.Meanwhile,the postoperative myocardial blush grade（MBG）,thrombolysis in myocardial infarction （TIMI）,corrected TIMI frame counts （CTFC）,ST-segment elevation resolution （STR） major adverse cardiac events （MACE）,and adverse reactions of adenosine were recorded.Results There was no significant difference in terms of postoperative TIMI and STR between two groups （P 〉 0.05）.The CTFC of observation group was （24.4 ± 4.9） frames,significant better than that of control group（（21.9 ±3.7） frames;t =2.701,P 〈0.01）.The ratio of MBG in observation group was 24/44,higher than that of control group（14/44 ; x^2 =4.632,P 〈 0.05）.There were no significant difference regarding of the ratio of death,MACE,target vessel revascularization,grade of NYHA between observation and control group at followed up for 1 and 12 month （P 〉 0.05）.The ratio of patients with blood pressure decrease ≥ 10 mm Hg,new second degree atrioventricular block in observation group were 15.9% and 20.5%,higher than that in control group （2.3% and 15.9% ; x^2 =4.950,7.221 ; P =0.026,0.007）.The adverse reaction was transient.Conclusion The intracoronary administration of tirofiban combined high-dose adenosine during PCI in patients with STEMI plays an effective role on improvement of myocardial perfusion.