抽吸导管联合盐酸替罗非班在PCI治疗急性心肌梗塞中的临床疗效研究

The Clinical Efficacy of the Thrombus Aspiration Catheter Combined with Tirofiban Hydrochloride in the Interventional Treatment of Acute Myocardial Infarction

目的通过研究抽吸导管联合非肽类血小板表面糖蛋白GPⅡb/Ⅲa受体拮抗剂(盐酸替罗非班注射液)经皮冠状动脉介入术(percutaneous coronary intervention,PCI)治疗急性心肌梗塞的临床应用,评价其疗效。方法 2012年1月至2017年10月,我科收治急性心肌梗塞拟行PCI的患者80例,随机分成2组,每组各40例。A组(抽吸导管联合盐酸替罗非班):通过导丝后直接给予盐酸替罗非班注入,送入抽吸导管行血栓抽吸后再置入支架。B组(常规肝素抗凝):通过导丝后直接给予球囊扩张,再根据病变情况置入支架。比较两组患者术中TIMI血流情况,术后肌酸激酶同工酶(CK-MB)、肌钙蛋白Ⅰ(TnⅠ)水平、ST段下降率,及术后30 d的主要心血管不良事件(MACE)等。结果 A组35例行导管抽吸后置入支架,5例患者血栓抽吸后同时注入替罗非班血流恢复正常,轻度狭窄,未置入支架;40例患者中只有2例出现TIMI 0~Ⅱ级。B组中有10例病人球囊扩张或支架植入后出现TIMI血流0~Ⅱ级(P<0.05)。A组病人术后CK-MB、TnⅠ水平低于B组(P<0.05),ST段回落幅度大于B组(P<0.05);A组患者恶性心律失常、心源性死亡、再发心肌梗死等并发症的总发生率低于B组(P<0.05)。结论在急性心肌梗塞急诊PCI术中,联合应用抽吸导管和盐酸替罗非班注射液可明显降低无复流发生率,明显减少MACE的发生,提高心肌灌注,并改善临床预后。

Objective To evaluate the clinical application of GPⅡb/Ⅲa receptor antagonist（ Tirofiban hydrochloride injection） combined with the thrombus aspiration catheter in the percutaneous coronary intervention（ PCI） treatment for acute myocardial infarction（ AMI）. Methods From January 2012 to October 2018,80 patients with AMI planned for PCI treatments in our department were randomly divided into 2 groups,with 40 cases in each. Group A received PCI following thrombus aspiration catheter insertion and tirofiban hydrochloride injection. Group B received PCI following heparin anti-coagulation. Results In group A,stents were implanted in 35 cases after catheter suction. 5 cases who were injected with tirofiban returned to normal blood flow with mild stenosis and had no stents inserted after thrombus aspiration. And only 2 cases appeared no reflow phenomenon. In group B,10 cases appeared no reflow phenomenon（ P〈0. 05） after balloon expansion or stent implantation. In group A,the levels of CK-MB and Tn I were lower than that of the control group（ P〈0. 05）. The incidence of malignant arrhythmia,cardiac death and recurrent myocardial infarction in group A were lower than that of the control group（ P〈0. 05）. Conclusion In the course of emergency PCI operation,thrombus aspiration catheter combined with Tirofiban hydrochloride injection can obviously reduce the incidence of no reflow phenomenon,reduce the occurrence of MACE,increase the myocardial perfusion and improve the clinical prognosis.