血栓抽吸并替罗非班加硝普钠冠脉内注射用于急性右冠状动脉闭塞患者PCI对冠脉血流、心功能的影响

Effect of PCI on Coronary Blood Flow and Cardiac Function in Patients with Acute Right Coronary Artery Occlusion by Thrombosis Aspiration and Tirofiban Combined with Sodium Nitroprusside Coronary Injection

目的:研究血栓抽吸并替罗非班加硝普钠冠脉内注射用于急性右冠状动脉闭塞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80例于本院行急诊PCI的急性下壁ST段抬高型心肌梗死(STEMI)患者,造影符合右冠状动脉闭塞并有较高血栓负荷者,依据随机数字表法分为直接PCI组(对照组,n=40)与血栓抽吸及替罗非班加硝普钠注入组(观察组,n=40)。观察两组PCI前后TIMI血流分级、心功能等指标及6个月不良心血管事件(MACE)的差异。结果:PCI术后,观察组TIMI血流2级及以上比例明显优于对照组(X^2=6.154,P=0.046),PCI术后2 h复查心电图观察组ST段回落>50%的比例明显多于对照组(X^2=5.000,P=0.025)。PCI术后1周,两组c Tn I峰值、CK-MB峰值、LVEF、LVEDD及LVESD比较,差异均无统计学意义(P>0.05)。PCI术后6个月,两组NT-pro BNP、LVEF、LVEDD及LVESD比较,差异均有统计学意义(P<0.05)。术后6个月观察组总体心血管事件明显少于对照组,两组比较差异有统计学意义(X^2=12.06,P=0.034)。结论:血栓抽吸并替罗非班加硝普钠冠脉内注射治疗急性右冠状动脉闭塞患者,可有效改善TIMI血流和术后远期心功能,减少远期不良心血管事件。

Objective: To study the effect of thrombus aspiration and intracoronary injection of Tirofiban combined with Sodium Nitroprusside in patients with acute right coronary artery reclusorisundergoing percutaneous coronary intervention(PCI) on blood flow and heart function in coronary heart disease thrombolysis(TIMI) assay. Method: Eighty patients with acute inferior ST-segment elevation myocardial infarction(STEMI) who underwent emergency PCI in our hospital were enrolled. The patients who underwent angiography with right coronary artery occlusion and high thrombus burden were randomly assigned to direct stent implantation group(the control group, n=40), thrombus aspiration and Tirofiban combined with Sodium Nitroprusside intracoronary injection treatment group(the observation group, n=40). The differences of TIMI blood flow grading, cardiac function and 6-month adverse cardiovascular events(MACE) of two groups were observed before and after PCI. Result: After PCI, TIMI blood flow grade 2 and above proportion of the observation group was significantly higher than that of the control group( X^2=6.154, P=0.046). Two hours after PCI review ECG, the rate of ST segment fall more than 50% in ECG the observation group was significantly higher than that in control group( X^2=5.000, P=0.025). 1 week after PCI, there were no significant differences in cTnI peak, CK-MB peak, LVEF, LVEDd and LVESD between two groups(P>0.05). 6 months after PCI, there were significant differences in NT proBNP, LVEF, LVEDd and LVESD between two groups(P<0.05). 6 months after operation, the total cardiovascular events in the observation group were significantly less than those in the control group, the difference between two groups was statistically significant( X^2=12.06, P=0.034). Conclusion: Thrombosis aspiration and Tirofiban combined with Sodium Nitroprusside coronary injection for the treatment of acute right coronary artery occlusioncan effectively improve blood flow of TIMI and long-term cardiac function after surgery, reduce long-term adverse cardiovascular events.