摘要
目的评价血栓抽吸导管联合硝普钠预防急性sT段抬高型心肌梗死（STEMI）直接经皮冠状动脉介入治疗（PCI）术中无复流的作用。方法连续人选2009年1月至2012年6月于我院就诊行直接经皮冠状动脉介入的STEMI患者，初始血管造影TIMI血流≤2级，行血栓抽吸之后，随机分配到A组（经血栓抽吸导管先注射固定剂量100ug硝普钠，然后注射替罗非班10I-Lg／kg）和B组（经血栓抽吸导管注射替罗非班10ug／kg）。主要终点为术后校正TIMI计帧数（cTFC）、心肌呈色分级（MBG）、完全sT段回落率（sTR）。二级终点包括TIMI血流分级、CK—MB峰值、6个月随访的主要心血管不良事件（MACE，靶血管重建、再次心梗、死亡）和左室射血分数（LVEF）。结果累计人选病例121例，A组60例，B组61例。两组之间的基本临床情况和血管造影特征无明显差异。A组与B组比较：①术后cTFC水平明显低（22~6比28~7，P=-O．01）；②STR明显高（75．0％比55．7％，P=O．04）；③MBG2～3级比例较高（70．O％比52．6％，P=-O．03）；④CK—MB峰值明显低（169±55比208±49，P=0．01）；⑤随访6个月LVEF水平明显高（62±4比54±5，P〈0．0001）。胸痛到PCI时间、入门至PCI时间、支架直径、支架长度均差异无统计学意义。应用硝普钠治疗期间无严重并发症。A组6个月的MACE事件发病率显示出降低趋势，但是差异无统计学意义（P=0．48）。结论在直接PCI术中经血栓抽吸导管预防性注射硝普钠．不仅改善心肌水平灌注而且减少心梗面积。
Objective To test the hypothesis that when administered in conjunction with thrombus aspiration catheter for treatment of ST elevation myocardial infarction （STEMI）, intracoronary administration of nitroprusside （NTP） plus tirofiban are safe and superior to IC administration of tirofiban alone for preventing no-reflow. Methods From January 2009 to June 2012, 121 consecutive patients with STEMI who received manual thrombus aspiration were involved in a double center prospectively analysis. Of them, 60 and 61 were treated with nitroprusside plus tirofiban （group A, n=60） and Tirofiban alone （group B, n=61 ）, respectively. The medications were selectively injected into the infarct-related artery（IRA）, through the occlusion to the distal segment via the thrombus aspiration catheter advanced into the IRA. Primary endpoints were postprocedural corrected thrombolysis in myocardial infarction frame count （cTFC）. The proportion of complete （〉70%） ST-segment resolutionand （STR）, myocardial blush grade 2-3（TMPG） post PCI. Secondary endpoints included peak value of creatine kinase-MB, TIMI flow grade, 6-month outcome including left ventricular ejection fraction （LVEF）, as wall as cardiac death, target vascular revascularization, re-infarction and their combination as major adverse cardiac events （MACE）. Results Baseline characteristics were not different between the two groups. Compared to group B, group A had： （1）A lower corrected TIMI coronary flame count（22±6 vs 28±7, P=-O.01 ）. （2）A higher proportion of complete ST-segment resolution（75.0% vs 55.7%, P=0.04）. （3）A better myocardial blush 2-3 grade ratio （70.0% vs 52.6%, P=0.03 ）. （4） A lower peak ereatine kinase-MB （169±55 vs 208±49, P=0.01 ）. There was no differences in TIMI 3 flow grade between the two groups（91.6% vs 93.4%, P=0.94）. No differences were found in cardiac death, TVR, re-infarction, MACE, between the two groups during 6-month follow-up, only an improvement trend in group A （log rank X2=0.51, P=0.48）. Nevertheless, the LVEF at 6 month was higher in group A （62±4 vs 54±5, P〈0.0001）. Conclusion Intracoronary administration 100 p.g NTP plus tirofiban, via the thrombus aspiration catheter advanced into the IRA, not only improve the myocardial reperfusion but also maybe improve the clinical prognosis.
出处
《中国心血管病研究》
CAS
2013年第7期488-493,共6页
Chinese Journal of Cardiovascular Research
基金
中国石油华北油田公司科技项目（项目编号：2012-HB-G09-4）
关键词
ST段抬高型心肌梗死
无复流现象
经皮冠状动脉介入治疗
血栓抽吸
硝普钠
ST elevation myocardial infarction
No-reflow phenomenon
Percutaneous coronary inter-vention
Thmmbus aspiration
Nitroprusside
