摘要
目的探讨急性ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉介入治疗(PCI)时,经抽栓导管向靶病变冠脉内注射依替巴肽或替罗非班后,术中发生无复流及术后主要心脏不良事件情况及临床疗效。方法连续入选105例资料齐全行急诊PCI的STEMI患者,随机分为单纯抽栓组(A组)、抽栓+冠脉内注射替罗非班组(B组)和抽栓+冠脉内注射依替巴肽组(C组)。随访6个月,比较3组患者术中无复流或慢血流的发生情况及在随访期间发生典型心绞痛、非致死性心肌梗死、心力衰竭和心源性死亡等主要心脏不良事件(MACE)的发生率,以及左室舒张末期内径(LVDd)、左室射血分数(LVEF)等指标变化情况。结果术后心肌梗死溶栓试验血流分级(TIMI)<2级、TIMI心肌灌注分级(TMP)<3级的比例为C组<B组<A组。随访6个月,左心室射血分数为A组<B组<C组,总MACE发生率B组和C组均低于A组,且C组低于B组。3组均无死亡事件,3组患者术后出血的比例差异无统计学意义(P>0.05)。结论对于STEMI患者行急诊PCI时,血栓抽吸联合依替巴肽可以获得更好的心肌水平再灌注,并且不增加出血及其他心脏不良事件的发生。
Objective To explore the clinical effects and the major adverse cardiac events of intracoronary eptifibatide or tirofiban injection by thrombus aspiration catheter in treatment of acute ST segment elevation myocardial infarction patients with primary percutaneous coronary intervention.Methods A total of 105 patients with STEMI underwent PCI were divided into thrombus aspiration group（ group A）,thrombus aspiration and intracoronary tirofiban group（ group B） and thrombus aspiration and intracoronary eptifibatide group（ group C）. All patients were followed up for 6 months,and major adverse cardiac events（ MACE） and the cardiac structure and function were compared by echocardiography among three groups. Results After primary PCI,myocardial tissue perfusion was significantly better in the group C than that in the group A and the group B（ TMP grade 〈3）. The incidence rates of MACE in the group B and the group C were significantly less than that in the group A（ P〈0.01）. LVEF in the group C was significantly higher than that in the group A and the group B（ P〈0.01）. Conclusion Intracoronary bolus application of eptifibatide by thrombus aspiration catheter after thrombus aspiration can achieve favorable myocardial reperfusion without increasing bleeding and other adverse cardiovascular events.
出处
《实用临床医药杂志》
CAS
2015年第23期7-11,共5页
Journal of Clinical Medicine in Practice
