CAJ | 학술논문

目的：探讨在急性ST段抬高型心肌梗死（ASTEMI）患者行急诊经皮冠状动脉介入治疗术（PCI）中进行血栓抽吸术并经抽吸导管冠状动脉内给予替罗非班的有效性和安全性。方法选择2011年8月-2013年8月收治的ASTEMI患者57例，随机分为2组，治疗组30例（静脉应用替罗非班，PCI术中行血栓抽吸，经抽吸导管行替罗非班冠状动脉内注射），对照组27例（单纯行PCI治疗，仅静脉应用替罗非班）。观察2组术后即刻的冠状动脉TIMI分级，以及手术前后肌酸激酶同工酶（ CK-MB）峰值；术后18．5 h心电图ST段回落指数（ STR）≥50％比率；比较术后1周及3个月时的左心室射血分数（LVEF）和左心室舒张末期内径（LVEDD）的变化；比较2组患者出血率及主要心血管不良事件（MACE）发生率。结果治疗组术后即刻冠状动脉造影TIMI 3级所占比例、术后1．5 h心电图STR≥50％比率均高于对照组（ P ＜0．05）；治疗组心肌酶CK-MB达峰时间显著短于对照组（ P ＜0．05）；术后1周、3个月时2组LVEDD及LVEF均有显著差异（ P ＜0．05）。2组患者术后大出血情况及MACE发生率比较无显著差异（ P ＞0．05）。结论急诊PCI术中应用血栓抽吸并经抽吸导管冠状动脉内给予替罗非班可增加心肌水平的血流灌注，减少坏死心肌数量，改善近期预后，疗效显著，安全性好。
목적：탐토재급성ST단태고형심기경사（ASTEMI）환자행급진경피관상동맥개입치료술（PCI）중진행혈전추흡술병경추흡도관관상동맥내급여체라비반적유효성화안전성。방법선택2011년8월-2013년8월수치적ASTEMI환자57례，수궤분위2조，치료조30례（정맥응용체라비반，PCI술중행혈전추흡，경추흡도관행체라비반관상동맥내주사），대조조27례（단순행PCI치료，부정맥응용체라비반）。관찰2조술후즉각적관상동맥TIMI분급，이급수술전후기산격매동공매（ CK-MB）봉치；술후18．5 h심전도ST단회락지수（ STR）≥50％비솔；비교술후1주급3개월시적좌심실사혈분수（LVEF）화좌심실서장말기내경（LVEDD）적변화；비교2조환자출혈솔급주요심혈관불량사건（MACE）발생솔。결과치료조술후즉각관상동맥조영TIMI 3급소점비례、술후1．5 h심전도STR≥50％비솔균고우대조조（ P ＜0．05）；치료조심기매CK-MB체봉시간현저단우대조조（ P ＜0．05）；술후1주、3개월시2조LVEDD급LVEF균유현저차이（ P ＜0．05）。2조환자술후대출혈정황급MACE발생솔비교무현저차이（ P ＞0．05）。결론급진PCI술중응용혈전추흡병경추흡도관관상동맥내급여체라비반가증가심기수평적혈류관주，감소배사심기수량，개선근기예후，료효현저，안전성호。
Objective To investigate efficacy and safety of thrombectomy and given tirofiban through catheter in acute ST-segment elevation myocardial infarction (ASTEMI ) patients who were underwent percutaneous coronary intervention (PCI).Methods From August 2011 to August 2013, select 57 admitted ASTEMI patients, they were randomly divided into two groups , the treatment group with 30 patients ( intravenous injected tirofiban , PCI with intraoperative thrombus aspiration , and intracoronary tirofiban injection ) , the control group with 27 patients ( treated with PCI alone , only intravenous injected tirofiban) .The coronary TIMI grade were observed immediately after intervention , as well as before and after intervention's isoenzyme of creatine kinase (CK-MB) peak; after 1.5 h ECG ST-segment resolution index (STR)≥50% rate; compare postoperative one week and three months'changes of left ventricular ejection fraction ( LVEF) and left ventricular end-diastolic diameter ( LVEDD);comparing two groups of patients bleeding rate and the incidence of main adverse cardiovascular events (MACE).Results Coronary angiography TIMI with grade of 3's proportion,1.5 h after intervention's electrocardiogram STR≥50%rate in the treatment group was higher than control group ( P <0.05 ); treatment group's time to peak cardiac enzyme CK-MB significantly lower than the control group ( P <0.05); cardiac ultrasound examination after 1 week and 3 months of intervention showed that 2 group's LVEDD, LVEF were significantly different ( P <0.05).There were no significant differ-ence of postoperative bleeding event and MACE in the two groups ( P >0.05).Conclusion Emergency PCI thrombus as-piration and intraoperative through the coronary give tirofiban can increase the level of myocardial perfusion and reduce the number of necrotic myocardium and improve short -term prognosis,with obvious therapeutic effect and good safety .