经抽吸导管冠状动脉内注射替罗非班对急诊介入治疗无复流的影响

Effect of trofiban injected into coronary artery via a suction catheteron on no reflow during PCI

目的探讨经抽吸导管冠状动脉注射血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班对急性ST段抬高型心肌梗死患者急诊PCI术中无复流的影响。方法 60例急诊PCI术并全部使用抽吸导管的急性ST段抬高型心肌梗死的患者随机分为2组,常规组30例,在急诊冠状动脉造影抽吸治疗后,经指引导管应用替罗非班,常规剂量外周静脉持续泵入;实验组30例,常规组基础上,经抽吸导管冠状动脉内注射替罗非班,常规剂量外周静脉持续泵入。比较2组围术期出血、梗死相关血管恢复前向血流情况。结果实验组首次用药的罪犯血管TIMI 2~3级比例显著高于常规组（86.67%vs 63.33%,χ2=4.356,P=0.037）;末次用药的罪犯血管TIMI 2~3级比例显著高于常规组（93.33%vs 70.00%,χ2=5.455,P=0.020）;实验组TIMI 3级比例显著高于常规组（66.67%vs 30.00%,P〈0.05）,2组表面出血和内脏出血比较,差异无统计学意义（3.33%vs 3.33%,3.33%vs 6.67%,χ2=0.351,P=0.554）。2组围术期和术后近期均无心脏不良事件发生。结论急性ST段抬高型心肌梗死患者在急诊PCI术时,经过抽吸导管注射替罗非班,能有效地改善梗死相关血管前向血流。

Objective To study the effect of trofiban（aplatelet glycoprotein Ⅱb/Ⅲa receptor）injected into coronary artery via a suction catheter on no reflow in patients with ST-segment elevation acute myocardial infarction during PCI.Methods Sixty patients with ST-segment elevation acute myocardial infarction who underwent emergency PCI via a suction catheter were randomly divided into control group（n=30）and experimental group（n=30）.The patients in control group were treated with catheter-guided trofiban injection after coronary angiography and those in experimental group were treated with trofiban injection via a suction catheter.The bleeding and infarction-related blood flow were compared between the 2groups during perioperative period.Results The culprit artery TIMI 2-3ratio and TIMI 3ratio were significantly higher in experimental group than in control group（86.67% vs 63.33%,χ2=4.356,P〈0.05;66.67% vs30.00%,P〈0.05）.No significant difference was found in bleeding between the two groups（3.33%vs 6.67%,χ2=0.351,P=0.554）.Conclusion Tirofiban injection via a suction catheter can effectively improve infarction-related blood flow in patients with ST-segment elevation acute myocardial infarction during emergency PCI.