不同给药途径注射硝普钠对急性冠脉综合症患者经皮冠状动脉介入术中无复流的疗效

Curative effect of nitroprusside injection through different administration routes on no-reflow during percutaneous coronary intervention in patients with acute coronary syndrome

目的：比较冠状动脉内经导引导管和经微导管注射硝普钠对急性冠脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）时无复流现象（NR）的疗效。方法选择四川省巴中市中心医院心内科2009年1月-2013年9月在实施PCI时出现靶血管NR的ACS患者55例，男性32例，女性23例。根据注射硝普钠的方式分为微导管组（n=31）和导引导管组（n=24），两组分别在NR时冠状动脉内注射硝普钠50μg/次，每2-5min重复直至NR消失。比较两组治疗前后TIMI血流分级、TIMI血流帧数（TFC）、不良反应和死亡的发生率。结果微导管组和导引导管组分别有29例（93.5%）和19例（79.2%）的患者TIMI血流分级改善，差异无统计学意义（P=0.22）。治疗后，微导管组TFC由（57.7±8.2）帧减少至（10.3±5.9）帧，导引导管组由（56.8±9.2）帧减少至（15.2±6.3）帧。两组治疗前后比较差异均有显著统计学意义（P均＜0.01），且治疗后微导管组TFC明显低于导引导管组（P＜0.05）。治疗后微导管组ITFC明显高于导引导管组[（0.82±0.11）vs.（0.73±0.11），P=0.004]。术后微导管组和导引导管组各有2例（6.5%）和5例（20.8%）住院期间死亡，差异无统计学意义（P＞0.05）。微导管组和导引导管组各有3例（9.7%）和5例（20.8%）发生一过性低血压，两组低血压发生率差异无统计学意义（P＞0.05）。结论经微导管注射硝普钠至靶血管远端治疗ACS患者PCI中NR疗效优于经导引导管。

Objective To compare the curative effect of intracoronary nitroprusside （NTP） injection through guiding catheter or micro-catheter on no-reflow （NR） during percutaneous coronary intervention （PCI） in patients with acute coronary syndrome （ACS）.Methods The ACS patients with NR of target vessel during PCI were chosen （n=55, male 32 and female 23） from Jan. 2009 to Sept. 2013. All patients were divided into micro-catheter group （n=31） and guiding catheter group （n=24）, and given intracoronary NTP injection （50 μg/time） during NR and given again every 2 min to 5 min until NR disappeared. The TIMI flow grading, TIMI flow frame count （TFC）, adverse reaction incidence and mortality were compared in 2 groups before and after treatment.Results There were 29 cases （93.5%） in micro-catheter group and 19 （79.2%） in guiding catheter group with improved TIMI flow grading （P=0.22）. After treatment, TFC decreased from （57.7±8.2） to （10.3±5.9） in micro-catheter group, and from （56.8±9.2） to （15.2±6.3） in guiding catheter group. The comparison between 2 groups before and after treatment had statistical difference （all P〈0.01）, and TFC was significantly higher in micro-catheter group than that in guiding catheter group after treatment （P〈0.05）. There were 2 cases （6.5%） in micro-catheter group and 5 （20.8%） in guiding catheter group died in hospital （P〉0.05）. There were 3 cases （9.7%） in micro-catheter group and 5 （20.8%） in guiding catheter group with temporary hypotension （P〉0.05）.Conclusion The curative effect of intracoronary NTP injection through micro-catheter is better than that through guiding catheter on NR during PCI in ACS patients.