摘要
目的:前瞻性随机比较急性ST段抬高型心肌梗死(STEMI)患者实施直接经皮冠脉介入(PCI)及血栓抽吸术中,经抽吸导管注射替罗非班与经静脉注射替罗非班的临床疗效。方法:入选因STEMI行直接PCI术并使用血栓抽吸患者113例,随机分为为超选组61例和静脉组52例,观察PCI后冠脉TIMI血流,心肌呈色分级,ST段回落程度,CK-MB峰值,术后血NT Pro-BNP值、术后LVEF及主要心血管事件(MACE)发生率。结果:①术后超选组较静脉组TIMI 3级血流获得率、心肌MBG 3级获得率及术后2hST段回落率高(P=0.019,0.027,0.037),超选组CK-MB峰值、术后7d及术后30dNT pro-BNP值较静脉组低(P=0.012,0.031,0.009);②术后30d超选组LVEF高于静脉组(P=0.045),LVEDd、LVESd小于静脉组(P=0.048,0.037);③超选组较静脉组总MACE发生有降低趋势,但差别无统计学意义(P=0.153)。结论:STEMI患者在行直接PCI及血栓抽吸术时经抽吸导管注射替罗非班可显著改善心肌再灌注及近期预后。
Objective：To compare the clinical efficacy of tirofiban injection through the thrombus aspiration catheter versus through the transvenous approach during primary percumneous coronary intervention（PPCI）in patients with acute ST-segment elevation myocardial（STEMI）.Method：113STEMI patients who received primary PCI and thrombus aspiration were selected.61of them were allocated to the special-selected group that received tirofiban injection through the thrombus aspiration catheter and 52of them were allocated to the transvenous group that received tirofiban injection through the intravenous injection.The TIMI flow grade of coronary,myocardial blush grade,the ST-segment resolution,the peak value of CK-MB,the value of NT pro-BNP,the left ventricle ejection fraction（LVEF）after PCI and major adverse cardiac events（MACE）rates were recorded.Result：①The thrombolysis in myocardial infarction（TIMI）grade 3flow of coronary,myocardial blush grade of 3（MBG-3）and the ST-segment resolution in special-selected group were superior than those in transvenous group（P=0.019, 0.027,0.037）.The peak value of CK-MB and the value of NT pro-BNP 7days and 30days after PCI in special-selected group were lower than those in transvenous group（P=0.012,0.031,0.009）;②The LVEF 30days after PCI in special-selected group were higher than those in transvenous group（P=0.045）,while the LVEDd and LVESd were lower than those in transvenous group（P=0.048,0.037）;③MACE rates in special-selected group were lower than that in transvenous group,but the difference was not statistically significant（P=0.153）.Conclusion：Tirofiban injection through the thrombus aspiration catheter is effective during primary PCI in STEMI,which will improve re-perfusion and short-term prognosis.
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2014年第5期384-387,共4页
Journal of Clinical Cardiology
基金
广东省科技计划项目资助(No:2012B061700012)
关键词
急性心肌梗死
经皮冠状动脉介入治疗
血栓抽吸导管
替罗非班
acute myocardial infarction
percutaneous coronary intervention
thrombus aspiration catheter
tiro-fiban
