摘要
目的分析应用替罗非班对ST段抬高性心肌梗死患者急诊行冠状动脉介入治疗冠状动脉血流和微循环的影响。方法ST段抬高性心肌梗死行直接冠状动脉介入治疗患者58例,随机分为替罗非班组(n=30)和对照组(n=28)。比较两组患者临床基础情况、冠状动脉介入治疗前梗死相关血管开通率、手术前后心肌梗死溶栓治疗血流情况、心电图ST段回落、术后内皮细胞凋亡数及凝血状态、住院期间出血事件、主要心脏不良事件发生率和出院前左心室射血分数等。结果替罗非班组使术前TIMI血流分级达到1级血流比例明显高于对照组(P<0.05),2级及3级血流两组之间差异无显著性(P>0.05),同时在对照组血流完全闭塞率高于替罗非班组(P<0.01),术中无复流现象、再灌注心律失常、内皮细胞凋亡数及凝血因子在替罗非班组均显著低于对照组(P<0.05),再通后90min心电图相关导联ST段回落值替罗非班组明显大于对照组(P<0.05),出院前左心室射血分数、两组患者主要心脏不良事件发生率和住院期间主要出血事件发生率差异无统计学意义(P>0.05)。结论替罗非班对急性ST段抬高性心肌梗死急诊行介入治疗可改善术前梗死相关血管TIMI血流情况,使介入手术顺利更好进行,争取更多时间避免较多的心肌细胞永久性坏死,改善心肌微循环障碍,减少无复流现象。
Aim To investigate the effect of tirofiban on coronary flow and microcirculation in patients with ST segment elevation myocardial infarction（STEMI） treated by primary percutaneous coronary intervention（PCI）.Methods 58 patients with primary STEMI who underwent primary PCI were randomized to receive either tirofiban and primary PCI（n= 30） or primary PCI alone（n= 28）.Baseline characteristics of the two groups were compared.The patency rate of infarct-related artery（IRA） before intervention,the flow of thrombolysis in myocardial infarction（TIMI） before and after surgery,the resolution of ST segment,endothelial cell apoptosis,blood coagulation factor,the incidence of bleeding complications and acute ischemic events during hospitalization as well as the left ventricular ejection fraction（LVEF） measured by echocardiography before discharge were studided.Results A greater percentage of TIMI 1 flow was achieved in the tirofiban group（P〈 0.05）.On the other hand,TIMI 0 flow was more commonly found in patients of the control group（P〈 0.01）.There was no difference between the two groups in percentage of TIMI 2 and 3 flow achieved in IRA after PCI（P〉 0.05）.The no-reflow phenomena,reperfusion arrhythmia,endothelial cell apoptosis,blood coagulation factor were less in the tirofiban group（P〈 0.05）,and faster ST segment resolution in the tirofiban group after PCI（P〈 0.05）.There was no significant difference between the two groups in occurrence of major adverse cardiovascular events（MACE） or bleeding in both groups.Conclusions Tirofiban treatment can improve the rates of recanalizationand and the TIMI flow to the acute myocardial infarction with PCI,the surgery can be done better.It can avoid more myocardial cell to die permanently,and improve microcirculation disfunction.
出处
《中国动脉硬化杂志》
CAS
CSCD
2007年第12期913-916,共4页
Chinese Journal of Arteriosclerosis
