冠状动脉内联合注射法舒地尔和替罗非班对PCI术中无复流的疗效观察

The Effect Comparison of Intracoronary Injection of Fasudil and Tirofiban in Patients with No-reflow During Primary PCI

目的评价急诊经皮冠状动脉介入治疗(PCI)中冠状动脉内联合应用法舒地尔及替罗非班与维拉帕米及替罗非班对急性心肌梗死无复流的疗效及安全性。方法选择2012年1月至2014年7月我科收治的急性ST段抬高心肌梗死行急诊PCI,梗死相关动脉开通后无复流患者108例,随机分为观察组和对照组各54例。两组患者手术方法相同,出现无复流现象后给予替罗非班,观察组给予法舒地尔对照组给维拉帕米。观察两组注射药物后无复流恢复时间、TMPG分级、术后1 h心电图ST段回落、左心功能及住院期间的主要心血管事件。结果观察组无复流恢复时间、TIMI血流分级、TMPG分级、心电图ST段回落、左室射血分数均高于对照组(P<0.05),观察组住院期间的MACE发生率低于对照组(P<0.05)。结论 AMI行急诊PCI出现无复流给予法舒地尔和替罗非班,可以增加STEMI患者PCI术中发生无复流现象后冠状动脉血流和心肌组织灌注,减少术后心绞痛及MACE的发生率,且未增加围手术期不良事件的发生。

Objective To compare the effect and security of intracoronary injection of fasudil combined with tirofiban, and verapamil combined with tirofiban on no-reflow during primary percutaneous coronary intervention（PCI） in patients with acute ST-segment elevation myocardial infarction（STEMI）. Methods A total of 108 STEMI patients underwent primary PCI with no-reflow phenomenon between January 2012 and July 2014 in our hospital were randomly divided into observation group and control group with 54 cases in each group. The patients of two groups are undergoing the same operation method. After occurrence of no-reflow phenomenon, intracoronary injecting tirofiban was in both group, the observation group were treated with fasudil and control group were given verapamil. The coronary angiography infarct-related artery no reflow recovery time, TIMI flow the corrected TIMI frame count（c TFC）, the incidence of angina pectoris and major adverse cardiac events（MACE）30 days after procedure and left ventricular ejection fraction（LVEF）were compared in two groups. Results The observation group of no reflow recovery time, TIMI flow grade, TMPG classification, ST segment of ECG down, left ventricular ejection fraction was higher than that of control group（P 0.05）, the observation group during hospitalization incidence of MACE was lower than that of the control group（P 0.05）. Conclusions Fasudil and Tirofiban used with no reflow after AMI emergency PCI Can increase the STEMI patients with PCI occurred in no flow and myocardial tissue perfusion of coronary artery reflow phenomenon. Reduce postoperative angina and the occurrence rate of MACE, and did not increase in the incidence of adverse events in peri operation period.