冠脉内注射替罗非班和硝普钠对PCI术中无复流的疗效

Therapeutic effect of intracoronary injection of tirofiban and sodium nitroprusside on slow flow or no-reflow during PCI

目的:探讨经冠脉内注射替罗非班和硝普钠对经皮冠状动脉介入(PCI)治疗过程中发生慢血流或无复流的疗效。方法:选择2012年1月至2014年12月在我院行PCI术的患者108例。根据术中冠脉TIMI血流情况,患者被分为正常血流组(40例)和无复流或慢血流组(68例,简称慢血流组)。通过比较两组基本临床资料,分析慢血流发生的影响因素。慢血流组被进一步随机均分为替罗非班组(34例,接受冠脉内替罗非班治疗)及联合治疗组(34例,在替罗非班组基础上冠脉内加用硝普钠),观察比较两组治疗后TIMI血流分级情况,以及术后1月的左室舒张末内径(LVEDd)和左室射血分数(LVEF)。结果:与正常血流组比较,慢血流组糖尿病(37.5%比61.8%)和急性心肌梗塞(20.0%比30.9%)比例显著升高(P均<0.05)。与替罗非班组比较,联合治疗组治疗后TIMI 3级患者比例(47.1%比79.4%)显著升高,P=0.029。与正常血流组比较,术后1月替罗非班组和联合治疗组的LVEDd[(52.40±5.65)mm比(56.97±7.61)mm,(58.13±8.80)mm]显著升高,LVEF[(51.72±8.51)%比(47.68±7.82)%,(47.12±7.58)%]显著降低,P<0.05或<0.01,而替罗非班组和联合治疗组间无显著差异(P均>0.05)。结论:对于PCI术中发生无复流或慢血流者给予硝普钠联合替罗非班能明显改善TIMI前向血流,改善预后。

Objective:To explore therapeutic effect of intracoronary injection of tirofiban and sodium nitroprusside on slow flow or no-reflow during percutaneous coronary intervention(PCI).Methods:A total of 108 patients undergoing PCI in our hospital from Jan 2012 to Dec 2014 were selected.According to their coronary TIMI blood flow condition,patients were divided into normal flow group(n=40)and no-reflow or slow flow group(n=68,slow flow group for short).Its influencing factors were analyzed through comparing clinical data of two groups.Slow flow group was further randomly and equally divided into tirofiban group(n=34,received intracoronary tirofiban therapy)and combined treatment group(n=34,received additional intracoronary sodium nitroprusside therapy based on tirofiban group).TIMI blood flow grade after treatment,left ventricular end-diastolic dimension(LVEDd)and left ventricular ejection fraction(LVEF)on one month after PCI were observed and compared between two groups.Results:Compared with normal flow group,there were significant rise in percentages of diabetes mellitus(37.5% vs.61.8%)and acute myocardial infarction(20.0% vs.30.9%)in slow flow group,P<0.05 both,there were no significant difference in other baseline data between two groups(P>0.05all).Compared with tirofiban group,there was significant rise in percentage of patients with TIMI grade 3(47.1% vs.79.4%)in combined treatment group,P=0.029.Compared with normal flow group on one month after PCI,there was significant rise in LVEDd[(52.40±5.65)mm vs.(56.97±7.61)mm,(58.13±8.80)mm],and significant reduction in LVEF [(51.72±8.51)%vs.(47.68±7.82)%,(47.12±7.58)%]in tirofiban group and combined treatment group,P<0.05or<0.01,but there were no significant difference between tirofiban group and combined treatment group,P>0.05 both.Conclusion:Tirofiban combined sodium nitroprusside can significantly improve TIMI anterior blood flow and improve prognosis in patients suffering from slow flow or no-reflow during PCI.