CAJ | 학술논문

目的比较对急性ST段抬高型心肌梗死(STEMI)患者行直接经皮冠状动脉介入(PCI)手术中应用血栓抽吸导管联合经抽吸导管与经指引管冠状动脉内注射替罗非班和硝酸甘油的疗效.方法选择因STEMI行直接PCI并于术中应用Diver CE血栓抽吸导管联合经抽吸导管冠状动脉内推注替罗非班和硝酸甘油的患者34例作为抽吸管组,以基础临床资料和冠状动脉影像特征相似并直接PCI中应用血栓抽吸导管联合经指引管冠状动脉内注射上述药物的33例患者作为指引管组,观察临床疗效.结果抽吸管组在注药前后血压变化差异无统计学意义(P＞0.05),但指引管组血压变化差异有统计学意义(P＜0.01),术后肌钙蛋白、血BNP值、CK-MB峰值、CK-MB峰值时间、TIMI 3级血流及梗死相关血管(IRA)慢血流发生率均优于指引管组(t值分别为3.92、4.70、3.39、7.17,P均＜0.01；x2值分别为3.877、3.876,P均＜0.05).两组术后1周时左心室射血分数(LVEF)、左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)比较差异均无统计学意义(P均＞0.05),但术后1个月抽吸管组LVEF、LVEDd、LVESd均优于指引管组(t值分别为5.99、4.53、8.12,P均＜0.01),而术后2hST回落率、1个月MACE发生率比较差异无统计学意义(P均＞0.05).结论 STEMI患者行直接PCI过程中与经指引导管冠状动脉内注药相比,应用血栓抽吸导管联合经抽吸导管冠状动脉内推注替罗非班和硝酸甘油可减少慢血流的发生,改善心肌再灌注水平及左心室功能.
목적 비교대급성ST단태고형심기경사(STEMI)환자행직접경피관상동맥개입(PCI)수술중응용혈전추흡도관연합경추흡도관여경지인관관상동맥내주사체라비반화초산감유적료효.방법 선택인STEMI행직접PCI병우술중응용Diver CE혈전추흡도관연합경추흡도관관상동맥내추주체라비반화초산감유적환자34례작위추흡관조,이기출림상자료화관상동맥영상특정상사병직접PCI중응용혈전추흡도관연합경지인관관상동맥내주사상술약물적33례환자작위지인관조,관찰림상료효.결과 추흡관조재주약전후혈압변화차이무통계학의의(P＞0.05),단지인관조혈압변화차이유통계학의의(P＜0.01),술후기개단백、혈BNP치、CK-MB봉치、CK-MB봉치시간、TIMI 3급혈류급경사상관혈관(IRA)만혈류발생솔균우우지인관조(t치분별위3.92、4.70、3.39、7.17,P균＜0.01；x2치분별위3.877、3.876,P균＜0.05).량조술후1주시좌심실사혈분수(LVEF)、좌심실서장말기내경(LVEDd)、좌심실수축말기내경(LVESd)비교차이균무통계학의의(P균＞0.05),단술후1개월추흡관조LVEF、LVEDd、LVESd균우우지인관조(t치분별위5.99、4.53、8.12,P균＜0.01),이술후2hST회락솔、1개월MACE발생솔비교차이무통계학의의(P균＞0.05).결론 STEMI환자행직접PCI과정중여경지인도관관상동맥내주약상비,응용혈전추흡도관연합경추흡도관관상동맥내추주체라비반화초산감유가감소만혈류적발생,개선심기재관주수평급좌심실공능.
Objective To compare the efficacy of thrombus aspiration catheter combined with intracoronary tirofiban and nitroglycerol injection through the aspiration catheter versus the guiding catheter during primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods Thirty-four patients with STEMI undergoing primary PCI and receiving thrombus aspiration catheter combined with intracoronary tirofiban and nitroglyeerol injection through the aspiration catheter were enrolled as the aspiration group (n =34),and those who had similar coronary angiography results and basic characteristics but receiving thrombus aspiration catheter combined with intracoronary tirofiban and nitroglycerol injection through the guiding catheter were served as the guiding group ( n =33 ).The outcomes of the two groups were observed and compared.Results There was no significant change of blood pressure between before and after injection in the aspiration group ( P ＞ 0.05 ),but the change of blood pressure was significant after injection compared with before injection in the guiding group ( P ＜ 0.01 ).The cTn-I,BNP,peak-value of CK-MB,peak-time of CK-MB,TIMI grade 3 flow,slow-reflow in IRA after PCI in the aspiration group were superior to those in the guiding group ( t =3.92,P ＜ 0.01 ;t =4.70,P ＜ 0.01 ; t =3.39,P ＜ 0.01 ; t =7.17,P ＜0.01 ; x2 =3.877,P ＜ 0.05 ; x2 =3.876,P ＜ 0.05 ).LVEF,LVEDd and LVESd after 1 month in the aspiration group were superior to those in the guiding group (t =5.99,P ＜ 0.01 ;t =4.53,P ＜ 0.01 ;t =8.12,P ＜ 0.01 ),but no significant differences of LVEF,LVEDd,LVESd were found after 1 week resolution of sum of ST-segment elevation and the MACE rates after PCI were found between the two group ( P ＞ 0.05 ).Conclusion Application of thrombus aspiration catheter combined with intracoronary tirofiban injection through the aspiration catheter is more effective than through the guiding catheter in patients with Acute ST-segment elevation myocardial infarction,which could decrease slow-reflow phenomenon and improve re-perfusion and left ventricular function with better clinical outcomes.