微导管注射替罗非班联合不同血管扩张剂对直接介入治疗中无复流的疗效比较

Effects of tirofiban combined with various vasodilator agents through microcatheter in patients with noreflow phenomenon during primary percutaneous coronary intervention

目的比较经微导管注射替罗非班联合不同血管扩张剂治疗直接介入治疗中无复流的疗效。方法选择急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)直接经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后发生无复流现象的86例患者,其中A组26例经微导管弹丸式注射硝普钠联合替罗非班,B组32例地尔硫艹卓联合替罗非班组,C组28例硝酸甘油联合替罗非班组。10 min后复查冠状动脉造影,应用心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)分级及校正的TIMI帧数(corrected TIMI frame count,CTFC)评定冠状动脉血流速度。结果 3组均可改善直接PCI治疗后无复流现象。A组治疗后2例恢复TIMI 2级血流,其余均恢复TIMI 3级血流;B组患者治疗后20例恢复TIMI 3级血流,10例恢复TIMI 2级血流,2例患者治疗后TIMI 1级;C组治疗后8例恢复TIMI 3级血流,13例恢复TIMI 2级血流,3例TIMI 1级,有4例治疗后TIMI 0级。A组治疗前、后CTFC帧数降低幅度明显高于B组和C组,差异有统计学意义(P<0.05)。A组改善冠状动脉血流方面明显优于另外两组,差异有统计学意义(P<0.05)。结论直接PCI治疗后,冠状动脉靶病变远端经微导管注射替罗非班联合硝普钠较联合地尔硫、硝酸甘油更有效改善无复流现象。

Objectives To compare the effects of tirofiban combined with various vasodilator agents through microcatheter in patients with no-reflow phenomenon during primary percutaneous coronary intervention（PCI）.Methods Totally 86 patients with ST-segment elevation myocardial infarction（STEMI）who sufferred no-reflow phenomenon after PCI were divided into three groups.Group A was with 26 patients who were injected with tirofiban combined with sodium nitroprusside by microcatheters in distal lesions.Group B was with 32 patients who were infused with tirofiban combined with diltiazem.Group C was with 28 patients who were infused with tirofiban combined with nitroglycerin.Coronary angiography was reviewed 10 minutes after injection.Thrombolysis in myocardial infarction（TIMI）and corrected TIMI framecount（CTFC） of target coronaries were assessed.Results No-reflow phenomenon were relieved in all the patients.Two patients in group A were recovered to TIMI grade 2 after injection,and the others were recovered to TIMI grade 3.Twenty patients in group B were recovered to TIMI grade 3,10 patients were recovered to TIMI grade 2,2patients were recovered to TIMI grade 1.Eight patients in group C were recovered to TIMI grade 3,13 patients were recovered to TIMI grade 2,3 patients were recovered to TIMI grade 1,and 4 patients were still in TIMI 0 grade.CTFCs of target coronaries most obviously decreased in group A（P〈0.05）.Differences in TIMI and CTFC among the three groups had statistical significance（P〈0.05）.Conclusions Tirofiban combined with sodium nitroprusside by microcatheters in distal lesions is a more effective and safer treatment for no-reflow phenomenon in patients with STEMI after primary PCI compared with either tirofiban combined with diltiazem,or tirofiban combined with nitroglycerin.