摘要
目的:观察替罗非班冠状动脉(冠脉)内给药联合血栓抽吸与替罗非班静脉给药对急性ST段抬高性心肌梗死直接经皮冠脉介入治疗(PCI)冠脉灌注和心功能的影响。方法:90例急诊行PCI术的急性ST段抬高性心肌梗死患者,随机分为两组,试验组为PCI中血栓抽吸同时冠脉内注射替罗非班,对照组仅常规PCI及静脉使用替罗非班。比较两组患者术后N末端B型利钠肽原(NT-proBNP)水平及采用超声心动图测定左心室舒张末期内径、左心室收缩末期内径、左心室射血分数(LVEF)和主要心脏不良事件(MACE,包括缺血性心绞痛发作、再次心肌梗死、心力衰竭、心源性猝死等)发生率。结果 :试验组术后梗死相关血管血流、心肌梗死溶栓治疗临床试验(TIMI)3级比例高于对照组(P<0.05),NTproBNP水平较低(P<0.05)。术后30天实验组左心室射血分数较高(P<0.05),左心室舒张末期内径、左心室收缩末期内径较低(P<0.05)、心脏不良事件发生率较少(P<0.05)。结论:急诊PCI术中梗死相关动脉注射替罗非班联合血栓抽吸较常规治疗可明显降低PCI术中无复流发生,改善血流再灌注及心功能。
Objective： To investigate the effect of thrombus aspiration with intra-infarct-related artery （IRA） tirofiban and intravenous tirofiban injection on cardiac function and no-reflow in patients of acute ST-elevation myocardial infarction （STEMI） with emergent PCI treatment. Methods： A total of 90 STEMI patients with emergent PCI treated in our hospital were enrolled and randomly divided into 2 groups. Experimental group, in which the patients received thrombus aspiration with IRA tirofiban injection during PCI, n=44, and Control group, the patients received intravenous tirofiban injection during PCI, n=46. The post procedural plasma levels of NT-proBNP and left ventricular end-systolic diameter （LVESD）, LVEDD, left ventricular ejection fraction （LVEF） and major adverse cardiovascular events （MACE） were examined and compared between two groups. Results： Compared with Control group, more patients in Experimental group achieved TIMI 3 flow and had lower level of plasma NT-proBNP, both P〈0.05. At 30 days after the operation, the Experimental group also showed higher LVEF, lower LVESD, LVEDD and MACE, all P〈0.05. Conclusion： Emergent PCI with IRA tirofiban injection may reduce the incidence of no-reflow, during PCI, therefore improve the cardiac function and early effect of treatment in STEMI patients.
出处
《中国循环杂志》
CSCD
北大核心
2013年第8期595-598,共4页
Chinese Circulation Journal
关键词
急性心肌梗死
急诊冠状动脉介入治疗
血栓抽吸
替罗非班
心功能
Acute myocardial infarction
Percutaneous coronary intervention
Thrombus aspiration
Tirofiban
Cardiac function
作者简介
陈春望主治医师学士主要从事冠心病介入治疗Email：zzstar1981@163．com通讯作者
