梗死相关动脉内血栓抽吸联合替罗非班注射对急性ST段抬高型心肌梗死的疗效观察

Effects of thrombus aspiration and tirofiban injection in infarct-related artery during PCI intervention for patients with ST-elevation acute myocardial infarction

目的观察梗死相关动脉(IRA)内血栓抽吸联合替罗非班注射对急性ST段抬高型心肌梗死(STEMI)的疗效。方法选择STEMI患者180例,随机分为三组,每组60例。A组给予IRA内血栓抽吸及替罗非班注射+经皮冠状动脉介入治疗(PCI),B组给予IRA内血栓抽吸+PCI,C组给予PCI。PCI术后1天(基础状态)及1年时进行心脏彩色多普勒超声检查,观察左心室收缩末期容积指数(LVESVI)、左心室舒张末期容积指数(LVEDVI)、左心室射血分数(LVEF)及心室重构情况。比较三组术后1周内出血情况及术后1年内不良心血管事件发生情况。结果 175例患者完成1年随访观察,A组1例于PCI术后第5天因心脏破裂死亡,B组2例、C组2例于PCI术后1年内发生心源性猝死。术后1年时,与B、C组比较,A组LVEDVI、LVESVI降低(P均<0.05),LVEF升高(P均<0.05);A组4例(6.7%)、B组12例(20.6%)、C组17例(29.3%)发生心室重构,A组心室重构率低于B、C组(P均<0.05);A组发生心绞痛复发3例、心功能不全2例、心源性猝死1例,不良心血管事件发生率为10.1%,B组分别为7、5、2例和24.1%,C组分别为9、8、2例和32.7%,A组不良心血管事件发生率低于B、C组(P均<0.05)。术后1周内三组均出现皮肤、黏膜、穿刺部位及牙龈轻度出血,无大出血或严重出血,三组出血情况比较,P均>0.05。结论 IRA内血栓抽吸联合替罗非班注射能够减少STEMI患者行PCI后心室重构发生,改善心脏功能,降低不良心血管事件的发生,且不增加出血风险。

Objective To observe the efficacy of thrombus aspiration and tirofiban injection in the infarct-related artery( IRA) during primary percutaneous coronary intervention( PCI) for patients with ST-elevation acute myocardial infarction( STEMI). Methods A total of 180 STEMI patients were randomly divided into three groups,60 cases in each group: group A which received the IRA thrombus aspiration and tirofiban injection + PCI,group B which received IRA thrombus aspiration + PCI and group C treated with PCI. The color Doppler ultrasound examination was performed at 1 day and 1 year after PCI to observe the left ventricular end systolic volume index( LVESVI),left ventricular end diastolic volume index( LVEDVI),left ventricular ejection fraction( LVEF) and ventricular remodeling. Hemorrhage events in a week and the cardiovascular events in a year among three groups were compared. Results After 1-year follow-up of 175 cases,1 case in the group A died of cardiac rupture on the fifth day after PCI; 2 cases in the group B and 2 cases in the group C died of sudden cardiac death in one year after PCI. One year after operation,LVEDVI and LVESVI were decreased,LVEF was increased in the group A as compared with those of the group B and group C( all P < 0. 05); the ventricular remodeling was found in 4 cases( 6. 7%) of group A,12 cases( 20. 6%) in the group B and 17 cases( 29. 3%) in the group C,and the remodeling rate of group A was lower than those of group B and group C( all P < 0. 05); in the group A,angina recurrence occurred in 3 cases,cardiac insufficiency was found in 2 cases,sudden cardiac death was found in 1 case,and the incidence of adverse cardiovascular events was 10. 1%,in the group B,they were 7,5,2 cases and 24. 1%,respectively,9,8,2 cases and 32. 7% in the group C,respectively,and the incidence of adverse cardiovascular events of group A was lower than that of group B and group C( all P < 0. 05). One week after operation in the three groups,the mild bleeding was found in the skin,mucous membrane,puncture sites and gingiva,but no massive hemorrhage or severe bleeding occurred,and no significant difference was found in bleeding among these three groups( all P > 0. 05). Conclusion Thrombus aspiration and tirofiban injection in the IRA during PCI can reduce ventricular remodeling of STEMI patients,improve the cardiac function,reduce the occurrence of cardiovascular events and do not increase the risk of hemorrhage.