摘要
目的 比较经靶向灌注导管在冠状动脉靶病变远端和经指引导管在冠状动脉靶病变近端注射血小板糖蛋白Ⅱb/Ⅲa抑制剂替罗非班和硝酸甘油,对ST段抬高型心肌梗死（STEMI）患者行直接经皮冠状动脉介入治疗（PCI）时对冠状动脉慢/无复流的作用.方法 回顾性分析2015年2月至2016年1月TIMI血流〈3级并行直接PCI术治疗的STEMI患者65例,其中经靶向灌注导管给药组35例,经指引导管给药组30例,评价给药前和PCI术后两组患者心外膜冠状动脉灌注及心肌组织灌注水平、术后院内主要不良心脑血管事件（MACCE）及出血事件的发生率.结果 两组患者一般资料比较差异未见统计学意义（P〉0.05）;经靶向灌注导管给药组心外膜冠状动脉灌注水平和心肌灌注水平显著优于经指引导管给药组（P〈0.01）;住院期间两组患者院内MACCE和出血事件发生率相当.结论 与经指引导管给药组相比,经靶向灌注导管在靶病变远端用药能显著改善STEMI患者心肌灌注水平,预防或减少冠状动脉无/慢复流的发生,且不增加院内MACCE和出血事件的发生率.
Objective To compare the effects of two approaches of intra-coronary administration of tirofiban and nitroglycerin （through perfusion micro-catheter verses through guiding catheter） on myocardial perfusion and clinical outcomes in patients with ST-segment elevation myocardial infarction （STEMI） underwent percutaneous coronary intervention（PCI）.Methods Sixty-five patients with STEMI with TIMI flow 〈 3 grade in target vessel and treated by PCI were retrospectively screened.Among them,35 patients received intracoronary administration of tirofiban and nitroglycerin through perfusion micro-catheter （observation group）.And 30 patients received intracoronary administration of tirofiban and nitroglycerin through guiding catheter （control group）.Baseline features,epicardial and myocardial perfusion,and in-hospital major adverse cardiac and cerebrovascular events （MACCE） and bleeding rates were compared.Results Baseline features were comparable between the two groups （P all 〉 0.05）.Compared with the control group,the patients in observation group obtained more favorable myocardial perfusion （P 〈0.01）.In-hospital MACCE rate and bleeding events were similar between the two groups（all P 〉 0.05）.Conclusions Intracoronary delivery of tirofiban and nitroglycerin through perfusion micro-catheter can improve myocardial perfusion in STEMI patients compared with intracoronary injection of tirofiban and nitroglycerin through guiding catheter,and also have similar in-hospital MACCE rate and bleeding events.
出处
《中国实用医刊》
2016年第19期17-20,共4页
Chinese Journal of Practical Medicine
