摘要
目的比较急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PPCI)中经改造球囊导管和经微导管注射硝普钠对无复流现象的临床疗效。方法选取2018年3-10月于该院行PPCI术中发生无复流的STEMI患者55例,分为改造球囊组(观察组,n=30)与微导管组(对照组,n=25),两组均冠状动脉内注入同等剂量的硝普钠,比较两组PPCI术后即刻TIMI血流分级、TIMI心肌组织灌注分级(TMPG)、术后ST段回落率(STR)、无复流至首次给药时间、无复流至血流恢复TIMI3级时间、术中不良反应发生率及耗材费用(除支架外)。结果两组术中靶血管构成比、PPCI术前的TIMI血流情况、植入支架个数构成比及长度、术中血管活性药物使用情况等比较,差异均无统计学意义(P>0.05)。两组通过不同方式给药后冠状动脉血流达到TIMI3级、心肌组织灌注恢复TMPG3级、STR≥50%患者百分比及术中不良反应发生率比较,差异均无统计学意义(P>0.05)。观察组无复流至首次给药时间、无复流至TIMI3级血流恢复时间、术中耗材费用(除支架外)均低于对照组(P<0.05)。结论经改造球囊导管冠状动脉内注射硝普钠可有效改善STEMI患者PPCI术中无复流现象,且给药速度更快、更经济。
Objective To compare the clinical efficacy of primary percutaneous coronary intervention(PPCI)via modified balloon catheters and microtubule-injected sodium nitroprusside in patients with acute ST-segment elevation myocardial infarction(STEMI)with no-reflow.Methods A total of 55 patients with STEMI who underwent non-reflow PPCI in this hospital from March to October 2018 were divided into the modified balloon group(observation group,n=30)and the microcatheter group(control group,n=25).The two groups were injected with the same dose of sodium nitroprusside in the coronary artery.The thrombolysis in myocardial infarction(TIMI)blood flow grading,TIMI myocardial perfusion grade(TMPG),postoperative ST segment fall rate(STR),and the occurrence of no-reflow phenomenon,the time of drug injection,the time of blood flow recovery TIMI-3,the incidence of intraoperative adverse reactions,and the cost of consumables(except for stents)were compared between the two groups.Results There were no significant difference in terms of intraoperative target vessel ratio,TIMI blood flow before PCI,number and length of implants,and intraoperative vasoactive drug use between the two groups(P>0.05).After administration in different ways,there was no significant difference in the percentages of cases with coronary blood flow reaching TIMI grade 3,myocardial tissue perfusion recovery reaching TMPG grade 3,STR≥50%and the rate of adverse reactions between the two groups(P>0.05).From the no-reflow to the first administration time,no-reflow to TIMI grade 3 blood flow recovery time,intraoperative consumables cost(except the stent)in the observation group were significantly lower than those in the control group(P<0.05).Conclusion Intracoronary injection of sodium nitroprusside in a modified balloon catheter can effectively improve the phenomenon of no-reflow in patients with STEMI received PPCI,and the drug delivery rate is faster and more economical.
作者
张霞
张红雨
梅莲莲
李江波
翟建涛
王淑静
ZHANG Xia;ZHANG Hongyu;MEI Lianlian;LI Jiangbo;ZHAI Jiantao;WANG Shujing(Department of Cardiology,Baodi Clinical College,Tianjin Medical University,Tianjin 301899,China)
出处
《重庆医学》
CAS
2019年第15期2617-2620,2629,共5页
Chongqing medicine
关键词
改造球囊
微导管
ST段抬高型心肌梗死
无复流现象
modified balloon
micro catheter
ST elevation myocardial infarction
no-reflow phenomenon
作者简介
张霞(1979-),副主任医师,在读博士,主要从事心血管内科疾病方面的研究。
