CAJ | 학술논문

目的探讨急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)时冠状动脉(冠脉)内注射负荷剂量盐酸替罗非班对心肌灌注及心功能的影响.方法选择2007年7月-2008年12月我科确诊STEMI并接受急诊PCI患者70例,随机分为观察组(36例)和对照组(34例).两组患者均进行PCI,术中观察组患者给予盐酸替罗非班10 μg/kg冠脉内注射,对照组给予等量0.9%氯化钠注射液冠脉内注射.比较两组患者PCI术后即刻造影结果,术后7、30、180 d的左室射血分数(EF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)及术后180 d主要不良心血管事件(MACE)发生率,同时观察住院期间的出血并发症.结果观察组患者术后校正TIMI 帧数、术后2 h ST段回落程度、磷酸肌酸激酶同工酶(CK-MB)峰值及峰值时间均优于对照组,差异有统计学意义(P<0.05);梗死相关血管无复流发生率及术后180 d MACE(包括死亡、再梗死、再次靶血管重建)发生率显著低于对照组,差异有统计学意义(P<0.05);与对照组比较,观察组术后7、30、180 d的EF显著增加,LVEDD、LVESD显著降低,差异有统计学意义(P<0.05).两组住院期间出血并发症的发生率间差异无统计学意义(P>0.05).结论对于STEMI患者行急诊PCI术中联合冠脉内注射替罗非班治疗可减少无复流、慢血流现象的发生,改善心肌水平再灌注状态和左室功能,同时不增加出血发生率,有利于提高临床预后.
목적 탐토급성ST단태고형심기경사(STEMI)환자급진경피관상동맥개입치료(PCI)시관상동맥(관맥)내주사부하제량염산체라비반대심기관주급심공능적영향.방법 선택2007년7월-2008년12월아과학진STEMI병접수급진PCI환자70례,수궤분위관찰조(36례)화대조조(34례).량조환자균진행PCI,술중관찰조환자급여염산체라비반10 μg/kg관맥내주사,대조조급여등량0.9%록화납주사액관맥내주사.비교량조환자PCI술후즉각조영결과,술후7、30、180 d적좌실사혈분수(EF)、좌실서장말기내경(LVEDD)、좌실수축말기내경(LVESD)급술후180 d주요불양심혈관사건(MACE)발생솔,동시관찰주원기간적출혈병발증.결과 관찰조환자술후교정TIMI 정수、술후2 h ST단회락정도、린산기산격매동공매(CK-MB)봉치급봉치시간균우우대조조,차이유통계학의의(P<0.05);경사상관혈관무복류발생솔급술후180 d MACE(포괄사망、재경사、재차파혈관중건)발생솔현저저우대조조,차이유통계학의의(P<0.05);여대조조비교,관찰조술후7、30、180 d적EF현저증가,LVEDD、LVESD현저강저,차이유통계학의의(P<0.05).량조주원기간출혈병발증적발생솔간차이무통계학의의(P>0.05).결론 대우STEMI환자행급진PCI술중연합관맥내주사체라비반치료가감소무복류、만혈류현상적발생,개선심기수평재관주상태화좌실공능,동시불증가출혈발생솔,유리우제고림상예후.
Objective To study the effects of primary percutaneous coronary intervention combined with tirofiban therapy on myocardial perfusion and clinical outcomes in STEMI patients in emergency percataneous coronary intervention(PCI).Methods Seventy STEMI patients receiving emergency PCI were divided randomly into groups tirofiban (n=36) and control (n=34).During PCI,tirofiban group were given intracoronary Tirofiban injection,10 μg/kg,and control group intracoronary 0.9% sodium chloride injection in the same dose.The postoperative immediate visualization results,left ventricular ejection fraction (EF),left ventricular end-diastolic dimension (LVEDD) and left ventricular end-systolic dimension (LVESD) on days 7,30,180 after intervention,major adverse cardiac events (MACE) on days 180 were compared between 2 groups,and the bleeding complications were observed during hospitalization.Results The tirofiban group were superior to control group in corrected TIMI frame count,falling degree of ST-segment elevation 2 h after operation,CK-MB peak and peak time,and in EF,LVEDD,LVESD on days 7,30,180,the difference was significant (P<0.05).The incidences of infarct-related artery no-reflow and of MACE (including death,reinfarction,target vessel re-reconstruction) 180 d after operation were lower in tirofiban group than in control,the difference was significant (P<0.05).No significant difference was noted in incidence of bleeding complications between 2 groups during hospitalization (P>0.05).Conclusion Emergency PCI combined with intracoronary tirofiban injection,reducing the incidence of no-reflow slow flow and improving myocardial reperfusion and left ventricular function without increasing bleeding incidence,is beneficial to clinical prognosis improvement.