硝普钠联合替罗非班对急性心肌梗死患者行经皮冠状动脉介入时无复流的影响

Effect of nitrioprusside combined with tirofiban on no-reflow phenomenon after percutaneous coronary intervention in patients with acute myocardial infarction

目的观察硝普钠联合替罗非班对急性心肌梗死患者行急诊经皮冠状动脉介入(PCI)术中无复流的疗效。方法将行急诊PCI术中出现无复流的100例急性前壁心肌梗死患者分为观察组52例和对照组48例。观察组患者冠状动脉无复流发生后冠状动脉内立即推注硝普钠(100μg)和替罗非班(400μg),对照组患者冠状动脉内立即推注硝酸甘油200μg。2组患者均于给药4 min后观察其心肌梗死溶栓治疗(TIMI)心肌灌注分级及TIMI血流分级,观察并记录患者住院期间及随访3个月内的主要心脏不良事件发生率,治疗3个月后比较患者左心室收缩同步性及舒张和收缩功能参数。结果观察组患者TIMI血流分级和心肌灌注分级达3级的比例均显著高于对照组(P<0.05)。观察组患者左心室峰射血率、左心室射血分数、左心室峰射血率时间等反映心脏收缩功能的指标优于对照组(P<0.05);观察组患者左心室峰充盈率、左心室峰充盈率时间、左心室舒张末压力等反映心脏舒张功能的指标也优于对照组(P<0.05);反映心室收缩同步性的参数,如峰相位、峰相位半高宽、相角程,观察组患者也均较对照组显著减小(P<0.05)。观察组患者住院期间及随访期间心脏主要不良事件发生率均低于对照组(P<0.05)。结论硝普钠联合替罗非班可明显改善PCI术中发生无复流后冠状动脉的血流和心肌组织灌注分级,增加左心室收缩同步性,提高左心室舒张和收缩功能,改善患者预后。

Objective To explore the effect of nitrioprusside combined with tirofiban on no-reflow phenomenon after percutaneous coronary intervention（ PCI） in patients with acute myocardial infarction. Methods One hundred acute anterior myocardial infarction patients who had no-reflow phenomenon after PCI were divided into observation group（ n = 52） and control group（ n = 48）. The patients in observation group were given intracoronary bolus nitroprusside（ 100 μg） and tirofiban（ 400 μg）; the patients in control group were given introcoronary nitroglycerin（ 200 μg）. The throbolysis in myocardial infarction（ TIMI） myocardial perfusion grade and TIMI blood flow grade of patients were recorded in the two groups at the first4 minutes after administration. The incidence of major adverse cardial events（ MACE） of patients in the hospital and in the follow-up period was recorded. The left ventricular systolic synchronization parameters（ LVSSP）,the left ventricular diastolic function parameters（ LVDFP） and the left ventricular systolic function parameters（ LVSFP） was compared between the two groups at 3 months after treatment. Results The number of patients with grade 3 of TIMI blood flow grade and myocardial perfusion grade was obviously higher than that in the control group（ P〈0. 05）. The LVSFP such as left ventricular peak ejection rate,left ventricular ejection fraction,left ventricular peak ejection rate time,and the LVDFP such as left ventricular peak rate,left ventricular peak rate time and left ventricular end-diastolic pressure of patients in observation group were good than those in the control group（ P〈0. 05）. Compared with control group,the LVSSP such as peak phase,peak phase and half high width and phase-shift of patients in observation group decreased（ P〈0. 05）. The incidence of MACE of patients in the hospital and in the follow-up period was lower than that in the control group（ P〈0. 05）. Conclusion Nitropursside combined with tirofiban can significantly improve the TIMI myocardial perfusion grade and TIMI blood flow grade in the acute myocardial farction patients with no-reflow phenomenon after PCI and can augment left ventricular systolic synchrony,improve left ventricular diastolic and systolic function and the prognostic of the patients.