血栓抽吸并替罗非班冠脉内注射用于急性心肌梗死患者PCI对冠脉血流、心功能的影响

Influence of thrombus aspiration combined intracoronary tirofiban injection on coronary blood flow and cardiac function in AMI patients undergoing PCI

目的:研究血栓抽吸并替罗非班冠脉内注射用于急性心肌梗死患者经皮冠脉介入治疗(PCI)对冠脉心肌梗死溶栓试验(TIMI)血流、心功能的影响。方法:选择120例于我院行PCI的急性ST段抬高型心肌梗死(STEMI)患者,随机分为单纯血栓抽吸组(60例)与替罗非班组(60例,血栓抽吸+替非罗班)。观察两组PCI前后TIMI血流分级,心功能,血管内皮功能等指标及3个月不良心血管事件(MACE)的差异。结果:PCI后,与单纯血栓抽吸组比较,替罗非班组TIMI 3级比例(75.00%比93.33%)、ST段回落≥50%率(78.33%比93.33%)明显提高,心肌肌钙蛋白I(cTnI)峰值[(73.39±7.45)μg/L比(68.78±6.92)μg/L]、肌酸激酶同工酶(CKMB)峰值[(252.98±26.71)μg/L比(226.57±24.42)μg/L]、内皮素(ET)-1[(97.95±10.26)ng/L比(88.75±9.06)ng/L]、血管假性血友病因子[vWF,(168.86±17.38)%比(145.86±17.38)%]、左室舒张末期容积指数[LVEDVI,(61.77±6.26)ml/m^2比(57.85±5.38)ml/m^2]、左室收缩末期容积指数[LVESVI,(43.23±4.46)ml/m^2比(39.48±4.14)ml/m^2]明显降低,一氧化氮[NO,(56.37±5.74)μmol/L比(61.95±6.17)μmol/L]、LVEF[(43.56±4.42)%比(39.48±4.14)%]明显提高,P<0.05或<0.01。替罗非班组MACE发生率明显低于单纯血栓抽吸组(8.33%比21.67%,P=0.042)。结论:血栓抽吸并替罗非班辅治PCI急性心肌梗死患者,可有效改善冠脉血流,心功能及血管内皮功能,减少不良心血管事件发生。

Objective： To study influence of thrombus aspiration （TA） combined intracoronary tirofiban injection on coronary blood flow and cardiac function in AMI patients undergoing PCI. Methods： A total of 120 patients with ST elevation myocardial infarction （STEMI） undergoing PCI in our hospital were selected. They were randomly and e-qually divided into pure TA group and tirofiban group （received TA ＋ tirofiban）. TIMI blood flow grade, cardiac function, vascular endothelial function indexes etc. before and after PCI and incidence rate of major adverse cardio- vascular events （MACE） on three month were observed and compared between two groups. Results： Compared with pure TA group after PCI, there were significant rise in percentages of TIMI grade 3 （75.00% vs. 93.33%） and ST segment regression ≥50% （78.33% vs. 93.33%）, NO level [（56.37 ± 5.74） μmol/L vs. （61.95 ± 6.17） μmol/L] and LVEF [ （43.56 ± 4. 42）% vs. （39. 48 ± 4. 14）%], and significant reductions in levels of peak cardiac troponin I [ （73. 39 ± 7. 45） μg/L vs. （68. 78 -＋ 6. 92） μg/L], creatine kinase isoenzyme MB [ （252.98 ± 26.71） μg/L vs. （226.57 ± 24.42） μg/L], endothelin-1 [- （97.95 ± 10.26） ng/L vs. （88.75 ± 9.06） ng/L], von Willebrand factor [ （168. 86 ± 17. 38）% vs. （145. 86± 17. 38）%], left ventrieular end-diastolic volume index （LVEDVI） [ （61.77 ± 6.26） ml/mz vs. （57.85 ±5.38） ml/m2] and LVSDVI [ （43.23 ± 4.46） ml/m2 vs. （39.48 ± 4. 14） ml/m2] in tirofi- ban group, P = 0. 001 all. Incidence rate of MACE in tirofiban group was significantly lower than that of pure TA group （8.33% vs. 21.67%, P = 0. 042）. Conclusion： Thrombus aspiration combined intracoronary tirofiban injec- tion can significantly improve coronary blood flow and cardiac function, vascular endothelial function and reduce in- cidence of adverse cardiovascular events in AMI patients undergoing PCI.