冠状动脉介入术中经微导管注射替罗非班处理无复流的疗效观察

The effect of tirofiban injected through microcatheter on no-reflow during percutaneous coronary intervention

目的探讨经皮冠状动脉介入术(PCI)中经微导管注入替罗非班处理无复流的临床疗效。方法以PCI术中出现无复流现象的冠心病患者为研究对象,采用随机数字表法分为替罗非班组和硝酸甘油组。当PCI术中出现无复流现象时,经微导管向冠状动脉病变远端分别迅速注入替罗非班或硝酸甘油,10min后行冠状动脉造影,评价靶血管TIMI血流分级。比较两组患者术前及术后24h血浆脑钠肽(BNP)、CK-MB水平、术前及术后4周左心室射血分数(LVEF)、左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)。结果共有46例冠心病患者PCI术中出现无复流现象,其中23例接受替罗非班治疗,23例接受硝酸甘油治疗。治疗后血流TIMI3级比率替罗非班组显著高于硝酸甘油组(P<0.05)。替罗非班组术后24h BNP、术后4周LVEDd、LVESd较硝酸甘油组低,LVEF、CK-MB均较硝酸甘油组高,其中两组BNP、LVEDd、LVESd、LVEF比较差异均有统计学意义(均P<0.05)。结论经微导管向冠状动脉远端注入替罗非班可有效改善PCI术中出现的无复流和术后心功能。

Objective To investigate the effect of tirofiban injected through microcatheter on no-reflow during percutaneous coronary intervention(PCI).Methods The patients with no-reflow phenomenon during PCI were enrolled and randomly divided into tirofiban group and nitroglycerin group.Tirofiban or nitroglycerin was injected through microcatheter into distal coronary artery as soon as no-reflow occurred during PCI.Angiography was performed again10minutes later to determine TIMI flow grade of the target vessels.BNP and CK-MB were measured before and at24hours after PCI.Left ventricular ejection fraction(LVEF),left ventricular end disatolic dimension(LVEDd)and end systolic dimension(LVESd)were determined before and at4weeks after PCI.Results46patients developed no-flow during PCI.Of them,23patients were treated with tirofiban and another23patients with nitroglycerin.The rate of TIMIⅢgrade flow was significantly higher in tirofiban group than in nitroglycerin group after treatment(P<0.05).NBP was lower and CK-MB was higher at24hours after PCI,LVEDd and LVESd were lower and LVEF was higher at4weeks after PCI in tirofiban group than in nitroglycerin(all P<0.05).Conclusion Tirofiban injected through microcatheter may improve no-reflow during PCI and heart function after PCI.