摘要
目的探讨在急性ST段抬高型心肌梗死(STEMI)接受直接冠状动脉介入治疗(PPCI)的患者中,应用静脉标准剂量比伐卢定的情况下,给予冠脉内注射替罗非班,对预防术中冠脉无复流的有效性。方法选取2017年3—8月在北部战区总医院心血管内科住院的急性STEMI接受PPCI的82例患者为研究对象,并采用随机数字表法将患者分为观察组(n=42)与常规组(n=40)。全部患者均给予标准剂量比伐卢定进行术中抗凝。在梗死相关动脉恢复至心肌梗死溶栓试验(TIMI)分级≥2级血流的情况下,观察组患者经指引导管、血栓抽吸导管或冠脉微导管一次性冠脉内注射替罗非班500μg,常规组患者经指引导管、血栓抽吸导管或冠脉微导管一次性冠脉内注射生理盐水10 ml。观察支架植入完成后即刻冠脉血流情况,包括TIMI血流及校正的TIMI血流帧数(CTFC)。结果观察组患者支架植入完成后靶血管即刻出现的无复流(TIMI血流≤2级或CTFC≥40)的发生率明显低于常规组(P<0.05)。结论急性STEMI接受PPCI患者中,在静脉应用比伐卢定进行全身抗凝的情况下,给予预防性冠脉内注射替罗非班对梗死相关动脉支架植入术后发生无复流具有较好的预防作用。
Objective To investigate the efficacy of intracoronary tirofiban of coronary arteries in patients with acute ST-elevation myocardial infarction(STEMI)receiving primary percutaneous coronary intervention(PPCI)with standard intravenous dose of bivalirudin.Methods A retrospective study was performed on 82 cases of acute STEMI patients who underwent PPCI from March to August 2017.Patients were randomly divided into the observation group(n=42)and the conventional group(n=40).All patients were given a standard dose of bivalirudin for intraoperative anticoagulation.In infarct related artery thrombolysis test back to myocardial infarction(TIMI)grade 2 or more blood flow,the observation group of patients through the guide catheter,suction catheter or coronary thrombus catheter of intravascular injection for tirofiban with 500μg,and the conventional group of patients through the guide catheter,suction catheter or coronary thrombus catheter one-time intravascular injection of saline 10 ml.Coronary blood flow was observed immediately after stent implantation,including TIMI blood flow and corrected TIMI blood flow frames(CTFC).Results The incidence of no reflow in the target vessel immediately after stent implantation in the observation group was significantly lower than that in the conventional group(P<0.05).Conclusion In patients receiving PPCI after acute STEMI,prophylactic intracoronary injection of tirofiban has a better preventive effect against non-reflow after infarct-related artery stent implantation in the case of systemic anticoagulation with intravenous bivalirudin.
作者
梁振洋
刘美丽
周鹤
王斌
刘海伟
关绍义
徐凯
韩雅玲
LIANG Zhen-yang;LIU Mei-li;ZHOU He;WANG Bin;LIU Hai-wei;GUAN Shao-yi;XU Kai;HAN Ya-ling(Department of Cardiology,Shanghai Changhai Hospital,Second Military Medical University,Shanghai 200433,China)
出处
《临床军医杂志》
CAS
2019年第4期338-341,326,共5页
Clinical Journal of Medical Officers
基金
"十三.五"重大慢性非传染性疾病防控研究(2016YFC1301303)
