血栓抽吸后应用替罗非班对心肌再灌注的影响(1)
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[摘要]目的 评估血栓抽吸联合经抽吸导管梗死相关动脉内注射替罗非班在急性ST段抬高心肌梗死急诊PCI治疗中的应用。方法 46例急诊PCI患者随机分为实验组(23例，血栓抽吸和经抽吸导管注药后行PCI)和对照组(23例，血栓抽吸后行PCI)。观察TIMI血流、肌钙蛋白I峰值、术后ST段下降率及左心室射血分数等。结果 实验组TIMI血流、肌钙蛋白I峰值、术后ST段下降率及左心室射血分数与对照组比较均有统计学意义。结论 血栓抽吸联合经抽吸导管应用替罗非班能改善急性ST段抬高心肌梗死患者心肌灌注及预后。
[关键词] 心肌梗死；梗死相关动脉内注射；替罗非班
[中图分类号] R541 [文献标识码] B [文章编号] 1673-9701(2011)23-60-02
Effects of Thrombus Aspiration plus Administration of Tirofiban on Myocardial Reperfusion in Patients with Acute Myocardial Infarction during Primary Angioplasty
WANG Yaohui QIAO Shuzhen QI Jiaxiang DUAN Xinjie
Department of Cardiology，the First People’s Hospital of Pingdingshan City in Henan Province，Pingdingshan 467000，China
[Abstract] Objective To evaluate the effects of thrombus aspiration plus intra-infarct-related artery administration of tirofiban in treatment of acute myocardial infarction (AMI) patients by primary pereutaneous coronary intervention (PCI).Methods All 46 patients with primary AMl who underwent primary PCI were randomized into two groups， experimental group(23 cases， were treated with thrombus aspiration plus intra-infarct-related artery administration of tirofiban)and control group(23 cases， were routinely treated by primary angioplasty after thrombus aspiration).The incidence of no reflow，peak of troponin I(TnI)，regression rate of ST segment and left ventricular ejection fraction(LVEF) were followed up after PCI during hospitalization. Results The target vessel forward flow of TIMI grade，peak of TnI，regression rate of ST segment and LVEF in experimental group showed the improvement in comparison with control group. Conclusion Thrombus aspiration plus intra-infarct-related artery bolus administration of tirofiban in patients with STEMI undergoing primary angioplasty may improve myocardium perfusion and result in a better clinical prognosis compared to primary angioplasty after thrombus aspiration.
[Key words] Myocardial infarction；Intra-infarct-related artery administration；Tirofiban
急性ST段抬高型心肌梗死(STEMI)行急诊经皮冠状动脉介入治疗(PCI)，是最有效的再灌注措施之一。直接PCI中几乎均能检测到梗死相关动脉远端出现栓塞微粒，因此许多患者虽能恢复心外膜冠状动脉血流灌注，仍存在微循环血流的受损，20%～40%的患者会发生无复流或慢血流现象，是影响患者远期预后的独立因素[1]。冠脉内血栓抽吸术是可以有效迅速去除阻塞冠脉血管的血栓，改善冠脉血流，但残留的血栓碎屑仍可导致远端微血管床栓塞；应用血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂有抗血小板的作用、抗栓和抗炎的作用 ......
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