摘要
目的探讨替罗非班给药途径及时机对急性心肌梗死(AMI)患者术中无复流的影响。方法选择2015年7月~2016年7月间就诊于九江市第一人民医院诊断为AMI并接受急诊经皮冠状动脉介入治疗(PCI)患者110例,根据替罗非班给药方式不同分为A、B1和B2三组。A组(32例)患者于急诊室静脉注射替罗非班,B组患者冠状动脉内注射替罗非班,其中B1(38例)组患者于血管开通前经指引导管注入,B2组(40例)患者于球囊扩张后或PCI后出现无复流时经微导管给药。其中A组及B1组患者如球囊扩张或PCI术后仍有无复流者可经指引导管再次注入替罗非班,其统计组不变。比较各组靶血管开通前后及支架植入后即刻TIMI血流分级和矫正TIMI血流帧(CTFC)计数、替罗非班给药剂量和术后出血情况。结果A组和B1组靶血管开通前TIMI血流分级和CTFC均优于B2组,差异有统计学意义(P<0.05),A组与B1组间比较差异无统计学意义(P>0.05);A组和B1组靶血管开通后TIMI血流分级优于B2组,差异有统计学意义(P<0.05),且B1组优于A组,差异有统计学意义(P<0.05);支架植入后即刻B2组靶血管TIMI血流分级和CTFC优于A组和B1组,差异有统计学意义(P<0.05),而A组和B1组两组间比较差异无统计学意义(P>0.05)。B2组术中替罗非班用量少于A组及B1组(P<0.05),但A组和B1组两组间比较差异无统计学意义(P>0.05)。B2组替罗非班给药剂量显著少于A组和B1组,B1组少于A组,差异有统计学意义(P<0.05);B2组术后出血发生率最低,且显著低于A组(P<0.05),与B1组比较差异无统计学意义(P>0.05)。结论替罗非班给药途径及时机不同对行PCI术治疗的AMI患者血流灌注影响不同,其中急诊室静脉注射能更早改善血流状态,而PCI术中冠状动脉内注射尤其是闭塞开通后给药对血流灌注的改善作用更强,替罗非班用量更小,术后出血更少。
Objective To explore the effects of tirofiban administrated at different routes and timing on no-reflow in patients with acute myocardial infarction. Method 110 AMI patients were divided into group A and group B （including B1 and B2） according to the different ways of administration. Group A （n=32） received intravenous tirofiban in the emergency department, group B was treated with tirofiban by intracoronary administration. Among them, group B1 （n=38） was injected via guide catheter before the vessel was opened. Patients in group B2 （n=40） were given tirofiban via microcatheterization after balloon dilatation or PCI when no reflow occurred. Among the group A and B1, tirofiban could be re-injected when there was no flow after balloon expansion or PCI. TIMI flow grade and corrected TIMI blood flow count （CTFC）, intraoperative tirofiban dosage, hospital adverse cardiac events （MACE）, and postoperative bleeding were compared before and after target vessel stenting and stent implantation. Results TIMI blood flow grade and CTFC were superior to group B2 （P〈0.05） in group A and group B1 before the target vessel is opened, and there was no statistically significant difference between A and B1 groups （P〉0.05）.The blood flow of TIMI in group A and group B1 was better than that in group B2 after the target vessel is opened （P〈0.05）, and B1 group was better to group A （P〈0.05）. TIMI blood flow grade and CTFC of target vessel in group B2 were better than that of group A and group B1 after Immediately stent implantation （P〈0.05）, and there was no significant difference between A and B1 groups （P〉0.05）. In group B2, the dosage of tirofiban was significantly less than that of group A and group B1 （P〈0.05）, and B1 group was less than that of group A （P〈0.05）. The incidence of postoperative bleeding in group B2 was the lowest, which was significantly lower than that in group A （P〈0.05）, and there was no significant difference compared with group B1 （P〉0.05）. Conclusion There have different effects on the blood perfusion of patients with AMI when treated with tirofiban on different routes and timing. In the emergency room intravenous tirofiban can improve coronary blood flow status earlier. Intracoronary injection of tirofiban during the PCI operation, especially after the opening of the occluded blood vessels, can more improved the blood perfusion with lower doses and less postoperative bleeding.
出处
《中国循证心血管医学杂志》
2017年第5期556-558,562,共4页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
江西省卫生计生委科技计划项目(20167106)
关键词
替罗非班
无复流
急性心肌梗死
经皮冠状动脉介入
Tirofiban
No-reflow
Acute myocardial infarction
Percutaneous coronary intervention
