摘要
目的观察经导引导管注射替罗非班联合尼可地尔或硝酸甘油对急性ST段抬高型心肌梗死(ST-seg-ment elevation myocardial infarction,STEMI)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗中出现无复流及慢血流现象的临床疗效。方法选取PCI治疗中发生无复流及慢血流现象的80例STEMI患者。随机分为替罗非班联合尼可地尔组(A组)、替罗非班联合硝酸甘油组(B组),每组各40例。术中发生无复流及慢血流现象时,两组分别经导引导管向冠状动脉靶血管迅速注入替罗非班联合尼可地尔(A组)、替罗非班联合硝酸甘油(B组)。比较5 min和10 min后冠状动脉靶血管心肌梗死溶栓试验(thrombolysis in myocar-dial infarction,TIMI)血流分级、患者低血压(血压<90/60 mmHg,1 mmHg=0.133 kPa)的发生率、术后再灌注心律失常发生率、术后2 h心电图ST段回落率、术前及术后24 h监测血浆脑钠肽前体(pro-brain natriuretic pep-tide,proBNP)浓度、术后1周查超声心动图测定左心室射血分数(left ventricular ejection fraction,LVEF)和左心室舒张末期内径(left ventricular end diastolic dimension,LVEDD)、住院期间并发症、90 d主要不良心血管事件(心绞痛、心源性猝死、心力衰竭)发生率。结果两组住院期间并发症、术前proBNP浓度比较,差异无统计学意义(P>0.05)。与B组相比,A组5 min和10 min后TIMI 3级血流患者比例明显高,术后出现低血压、再灌注心律失常发生率低、术后2 h心电图ST段回落率高,差异有统计学意义(P<0.05)。两组术后24 h proBNP浓度、术后1周LVEF、LVEDD比较,差异无统计学意义(P>0.05);但A组与B组相比,90 d主要不良心血管事件发生率低,差异有统计学意义(P<0.05)。结论替罗非班联合尼可地尔疗效优于替罗非班联合硝酸甘油,可以快速恢复STEMI患者PCI治疗中无复流及慢血流现象后冠状动脉血流,减少低血压、再灌注心律失常的发生,改善心肌缺血,
Objectives To observe the clinical curative efficacy of catheter-guided injection of tirofiban combined with nicorandil or nitroglycerin in acute ST-segment elevation myocardial infarction(STEMI)patients with no-reflow or with slow blood flow in percutaneous coronary intervention(PCI).Methods Totally80STEMI patients with no?reflow or with slow blood flow performed PCI were enrolled and were randomly divided into the tirofiban combined nicorandil group(group A)and the tirofiban combined nitroglycerin group(B group),with40patients in each group.When no reflow or slow blood flow occurred during PCI,tirofiban combined nicorandil(group A)and tirofiban combined nitroglycerin(group B)were immediately injected into the target vessels of coronary artery through the catheter,respectively.Thrombolysis in myocardial infarction(TIMI)blood flow classification of target vessels of coronary artery after5min and10min,incidence of hypotension(blood pressure<90/60mmHg;1mmHg=0.133kPa),incidence of arrhythmia after post-operative reperfusion,ST-segment depression rate on electrocardiogram(ECG)2h after PCI,plasma concentrations of pro-brain natriuretic peptide(proBNP)monitored24h before and after PCI,left ventricular ejection fraction(LVEF)and left ventricular end diastolic diameter(LVEDD)measured by echocardiography in1week after PCI,complications during hospitalization and incidence of major adverse cardiovascular events(MACE)(angina pectoris,sudden cardiac death,heart failure)in90days were compared between the two groups.Results There were no significant differences in incidence of complications during hospitalization and plasma concentration of proBNP between the two groups(P>0.05).Compared with group B,proportions of patients with TIMI grade3blood flow after5min and10min were significantly higher and occurrence rate of hypotension,incidence of arrhythmia after postoperative reperfusion and ST?segment depression rate in2h after PCI were higher,and the differences had statistical significance(P<0.05).Differences in plasma concentra
作者
陈雷
李平
王正东
谢文超
陈坚
林智海
梁祥文
CHEN Lei;LI Ping;WANG Zheng-dong;XIE Wen-chao;CHEN Jian;LIN Zhi-hai;LIANG Xiang-wen(The First People′s Hospital of Yulin City,Yulin,Guangxi 537000,China)
出处
《岭南心血管病杂志》
2018年第6期630-633,679,共5页
South China Journal of Cardiovascular Diseases
