中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2012年
4期
290-293
,共4页
冠状动脉疾病%血管成形术,经腔,经皮冠状动脉%维拉帕米
冠狀動脈疾病%血管成形術,經腔,經皮冠狀動脈%維拉帕米
관상동맥질병%혈관성형술,경강,경피관상동맥%유랍파미
oronary artery disease%Angioplasty,transluminal,percutaneous coronary%Verapamil
目的 探讨急性冠状动脉(冠脉)综合征(ACS)患者急诊经皮冠脉介入治疗(PCI)时冠状动脉内应用维拉帕米的近期疗效和安全性. 方法 同期开放标签随机对照临床试验,入选我院2009年4月至2011年5月ACS患者98例.在应用阿司匹林、氯呲格雷、低分子肝素的基础上,数字抽签随机分为维拉帕米组(48例)和对照组(50例),维拉帕米组在支架释放后即刻将维拉帕米200 μg加入2 ml肝素生理盐水行冠脉内注入,对照组在支架释放后即刻冠脉内注入肝素生理盐水2 ml.比较两组PCI术前、术后和冠脉内注药后的冠脉灌注和心肌灌注水平；并比较两组住院、随访期间主要心脏不良事件的发生率. 结果 两组间冠脉支架释放后即刻冠脉灌注和心肌灌注水平比较,差异无统计学意义(P＞0.05):维拉帕米组冠脉内注入维拉帕米后校正的心肌梗死溶栓试验(TIMI)帧数(CTFC)(t=6.47,P＜0.01)、梗死相关血管的TIMI血流分级(x2=5.17,P＜0.01)、TIMI心肌灌注分级(TMPG,x2 =8.25,P＜0.01)和心肌灌注显彤分级(MBG,x2=2.12,P＜0.05)均较对照组改善:经对维拉帕米应用影响因素校正后,CTFC仍有改善(x2=2.36,P＜0.05),TFG(x2=0.58,P＞0.05)、MBG(x2=0.91,P＞0.05)有改善的趋势,维拉帕米组和对照组TMPG比较,差异无统计学意义(x2=0.68,P＞0.05).两组PCI术后1周心脏超声检查结果差异无统计学意义(x2=0.65,P＞0.05)；两组住院期间、术后1个月和3个月随访期主要心脏不良事件发生率分别为12.5％(6例)和14.0％(7例),差异无统计学意义(x2 =0.71,P＞0.05). 结论 老年ACS患者急诊经PCI治疗时冠脉内应用维拉帕米可改善相关血管的T1M1血流,老年患者可耐受,安全可靠,可在临床推广应用.
目的 探討急性冠狀動脈(冠脈)綜閤徵(ACS)患者急診經皮冠脈介入治療(PCI)時冠狀動脈內應用維拉帕米的近期療效和安全性. 方法 同期開放標籤隨機對照臨床試驗,入選我院2009年4月至2011年5月ACS患者98例.在應用阿司匹林、氯呲格雷、低分子肝素的基礎上,數字抽籤隨機分為維拉帕米組(48例)和對照組(50例),維拉帕米組在支架釋放後即刻將維拉帕米200 μg加入2 ml肝素生理鹽水行冠脈內註入,對照組在支架釋放後即刻冠脈內註入肝素生理鹽水2 ml.比較兩組PCI術前、術後和冠脈內註藥後的冠脈灌註和心肌灌註水平；併比較兩組住院、隨訪期間主要心髒不良事件的髮生率. 結果 兩組間冠脈支架釋放後即刻冠脈灌註和心肌灌註水平比較,差異無統計學意義(P＞0.05):維拉帕米組冠脈內註入維拉帕米後校正的心肌梗死溶栓試驗(TIMI)幀數(CTFC)(t=6.47,P＜0.01)、梗死相關血管的TIMI血流分級(x2=5.17,P＜0.01)、TIMI心肌灌註分級(TMPG,x2 =8.25,P＜0.01)和心肌灌註顯彤分級(MBG,x2=2.12,P＜0.05)均較對照組改善:經對維拉帕米應用影響因素校正後,CTFC仍有改善(x2=2.36,P＜0.05),TFG(x2=0.58,P＞0.05)、MBG(x2=0.91,P＞0.05)有改善的趨勢,維拉帕米組和對照組TMPG比較,差異無統計學意義(x2=0.68,P＞0.05).兩組PCI術後1週心髒超聲檢查結果差異無統計學意義(x2=0.65,P＞0.05)；兩組住院期間、術後1箇月和3箇月隨訪期主要心髒不良事件髮生率分彆為12.5％(6例)和14.0％(7例),差異無統計學意義(x2 =0.71,P＞0.05). 結論 老年ACS患者急診經PCI治療時冠脈內應用維拉帕米可改善相關血管的T1M1血流,老年患者可耐受,安全可靠,可在臨床推廣應用.
목적 탐토급성관상동맥(관맥)종합정(ACS)환자급진경피관맥개입치료(PCI)시관상동맥내응용유랍파미적근기료효화안전성. 방법 동기개방표첨수궤대조림상시험,입선아원2009년4월지2011년5월ACS환자98례.재응용아사필림、록자격뢰、저분자간소적기출상,수자추첨수궤분위유랍파미조(48례)화대조조(50례),유랍파미조재지가석방후즉각장유랍파미200 μg가입2 ml간소생리염수행관맥내주입,대조조재지가석방후즉각관맥내주입간소생리염수2 ml.비교량조PCI술전、술후화관맥내주약후적관맥관주화심기관주수평；병비교량조주원、수방기간주요심장불량사건적발생솔. 결과 량조간관맥지가석방후즉각관맥관주화심기관주수평비교,차이무통계학의의(P＞0.05):유랍파미조관맥내주입유랍파미후교정적심기경사용전시험(TIMI)정수(CTFC)(t=6.47,P＜0.01)、경사상관혈관적TIMI혈류분급(x2=5.17,P＜0.01)、TIMI심기관주분급(TMPG,x2 =8.25,P＜0.01)화심기관주현동분급(MBG,x2=2.12,P＜0.05)균교대조조개선:경대유랍파미응용영향인소교정후,CTFC잉유개선(x2=2.36,P＜0.05),TFG(x2=0.58,P＞0.05)、MBG(x2=0.91,P＞0.05)유개선적추세,유랍파미조화대조조TMPG비교,차이무통계학의의(x2=0.68,P＞0.05).량조PCI술후1주심장초성검사결과차이무통계학의의(x2=0.65,P＞0.05)；량조주원기간、술후1개월화3개월수방기주요심장불량사건발생솔분별위12.5％(6례)화14.0％(7례),차이무통계학의의(x2 =0.71,P＞0.05). 결론 노년ACS환자급진경PCI치료시관맥내응용유랍파미가개선상관혈관적T1M1혈류,노년환자가내수,안전가고,가재림상추엄응용.
Objective To examine the clinical efficacy and safety of intracoronary verapamil during percutaneous coronary intervention(PCI) in patients with acute coronary syndromes (ACS).Methods Totally 98 patients with ACS undergoing PCI were randomly assigned to two groups:verapamil group (immediately intracoronary verapamil 200 μg/2 ml heparinised saline,n=48) and intracoronary saline control group (immediately intracoronary 2 ml heparinised saline,n=50) after deploying stent.The follow up time was 3 months.Thrombolysis in myocardial infarction (TIMI)flow grade (TFG), corrected TIMI frame count (CTFC),TIMI myocardial perfusion grade (TMPG), myocardial blush grade (MBG) were assessed pre- and post-PCI and after drug administration.Echocardiography were performed one week after PCI. Incidence of major adverse cardiac events in hospital and 3 months follow-up were compared between the two groups. Results The differences in values of CTFC,TFG,TMPG,MBG after PCI were not found between two groups (P＞0.05). However,after intracoronary drug administration,verapamil group was superior to control group in terms of CTFC (t=6.47,P＜0.01),TFG (x2=5.17,P＜0.01),TMPG(x28.25,P＜0.01)and MBG(x2=2.12,P＜0.05).After correcting the influencing factors,only CTFC was still improved in verapamil group than in control group (x2 =2.36,P＜0.05).There were no significant differences between the two groups in TFG(x2 =0.58,P＞0.05)and MBG(x2 =0.91,P＞0.05) and TMPG (x2 =0.68,P＞0.05).Echocardiographic results after PCI were similar between two groups (x2 =0.65,P＞0.05).There was no difference in major adverse cardiac events between two groups (x2 =0.71,P ＞ 0.05 ). Conclusions Application of intracoronary verapamil after deploying stent is effective,safety and worthy of popularization in view of improving post procedural coronary flow in patients with ACS.
