不同方法注射硝普钠在急性ST段抬高型心肌梗死急诊介入治疗中预防无复流的对照研究

A comparative study on the prevention of no-reflow phenomenon during primary percutaneous coronary intervention of acute ST-segment elevation myocardial infarction by injecting sodium nitroprusside through guiding catheter and thrombus aspiration catheter

目的观察急性ST段抬高型心肌梗死(STEMI)患者急诊介入术(PPCI)中两种应用硝普钠方式对于预防无复流现象(NRP)及相关指标的影响。方法选取高血栓负荷的STEMI病例110例,随机分为导引导管组和抽吸导管组,每组55例。在急诊介入操作中,于支架植入前,分别采用经导引导管和经抽吸导管梗死相关动脉远端两种方式注射硝普钠。比较2组患者PPCI即刻NRP发生率、梗死相关血管心肌梗死溶栓试验(TIMI)分级、TIMI心肌灌注分级(TMPG)、ST段回落率(STR)及6个月后左心室射血分数(LVEF)、左室舒张末内径(LVD)、N末端脑钠肽前体(NT-proBNP)、主要心血管不良事件(MACE)发生率。结果2组基线情况比较,差异无统计学意义(P>0.05)。术后NRP抽吸导管组低于导引导管组(3.64%、10.91%,P=0.018)。抽吸导管组TIMI分级、TMPG、STR均优于导引导管组(P<0.05)。术后6个月抽吸导管组LVEF、LVD、NT-proBNP优于导引导管组(P<0.05);2组术后6个月随访,MACE事件比较,差异无统计学意义(P>0.05)。结论经抽吸导管途径使用硝普钠预防STEMI患者PPCI术后发生NRP及STR更加有效,能改善PPCI后6个月心室重构及降低NT-proBNP。

Objective To investigate the effects of two kinds of sodium nitroprusside(SNP)application methods on the prevention of no-reflow phenomenon(NRP)and related indexes in patients with acute ST-segment elevation myocardial infarction(STEMI)during primary percutaneous coronary intervention(PPCI).Methods A total of 110 patients with STEMI and high thrombus burden who were treated in our hospital were randomly divided into guiding cathete group(n=55)and thrombus aspiration catheter group(n=55).Before the stent was implanted.SNP was injected through two ways:guided catheter and thrombus aspiration catheter.The incidence rate of NRP in PPCI immediately,thrombolysis in myocardial infarction(TIMI)blood flow,TIMI myocardial perfusion grading(TMPG),and ST segment resolution rate(STR)after PPCI as well as the left ventricular ejection fraction(LVEF),left ventricular end diastolic(LVD),N terminal pro B type natriuretic peptide(nT-proBNP)and the incidence rates of major adverse cardiac events(MACE)after 6-month treatment were observed and compared between the two groups.Results There were no significant differences in the basic indexes between the two groups(P>0.05).The incidence rate of NRP in thrombus aspiration catheter group was significantly lower than that in guiding catheter group(3.64%vs 10.91%,P<0.05).TIMI,TMPG and STR in thrombus aspiration catheter group were significantly better than those in guiding catheter group(P<0.05).After 6-month treatment,the LVEF,LVD and NT-proBNP in thrombus aspiration group were superior to those in guiding catheter group(P<0.05).Moreover there were no significant differences in the incidence rates of MACE after 6-month follow between the two groups(P>0.05).Conclusion The SNP injection through thrombus aspiration catheter can more effectively prevent the incidence of NRP and STR in patients with STEMI after PPCI operation,which can improve ventricular remodeling and reduce NT-proBNP levels at 6 months after PPCI.