CAJ | 학술논문

目的：观察在急诊行经皮冠状动脉介入治疗（PCI）前静脉应用替罗非班的基础上，加用冠脉内注射对治疗急性ST段抬高型心肌梗死（STEMI）患者的疗效。方法选取2012年1月～2013年8月急诊确诊为急性STEMI患者112例，随机分为治疗组（n＝56）和对照组（n＝56），治疗组在急诊给予静脉泵入替罗非班0．15μg/（kg? min）维持24h，PCI时给予冠脉内注射替罗非班5μg/（kg? min），对照组直接行PCI。观察两组患者PCI后心肌梗死溶栓治疗试验分级（TIMI）及TIMI心肌灌注分级（TMPG），校正的TIMI计帧数（CTFC），PCI后90min ST段回落幅度及临床预后。结果实验组在PCI术后TIMIⅢ级血流及CTFC、TMPGⅢ级、90min ST段回落程度及1个月时LVEF 均优于对照组（ P ＜0．05）。两组患者住院期间出血事件及主要心血管不良事件（MACE）差异无统计学意义（P＞0．05）。结论对急性STEMI患者行急诊PCI前静脉使用替罗非班加PCI时冠脉内注射，不仅可以提高TIMI及TMPG的分级，有利于改善缺血心肌再灌注，而且可以改善患者的临床预后。
목적：관찰재급진행경피관상동맥개입치료（PCI）전정맥응용체라비반적기출상，가용관맥내주사대치료급성ST단태고형심기경사（STEMI）환자적료효。방법선취2012년1월～2013년8월급진학진위급성STEMI환자112례，수궤분위치료조（n＝56）화대조조（n＝56），치료조재급진급여정맥빙입체라비반0．15μg/（kg? min）유지24h，PCI시급여관맥내주사체라비반5μg/（kg? min），대조조직접행PCI。관찰량조환자PCI후심기경사용전치료시험분급（TIMI）급TIMI심기관주분급（TMPG），교정적TIMI계정수（CTFC），PCI후90min ST단회락폭도급림상예후。결과실험조재PCI술후TIMIⅢ급혈류급CTFC、TMPGⅢ급、90min ST단회락정도급1개월시LVEF 균우우대조조（ P ＜0．05）。량조환자주원기간출혈사건급주요심혈관불량사건（MACE）차이무통계학의의（P＞0．05）。결론대급성STEMI환자행급진PCI전정맥사용체라비반가PCI시관맥내주사，불부가이제고TIMI급TMPG적분급，유리우개선결혈심기재관주，이차가이개선환자적림상예후。
Objective To observe the curative effect of intracoronary injection to patients with ST-elevation myocardial infarction (STEMI)on the basis of intravenous injection of Tirofiban before primary pecutaneou coronary intervention (PCI).Methods One hundred and twelve patients diagnosed with STEMI during January 2012 to Augest 2013 were randomly divided into the treatment group (n=56)and the control group(n=56).The treatment group was given intravenous injection of tirofiban 0.15μg/(kg? min) in the emergency department for 24 hours and given intracoronary injection of tirofiban 5μg/(kg? min) when treated with PCI;the control group was treated with PCI di-rectly.The thrombolysis in myocardial infarction (TIMI) grading,the TIMI myocardial perfusion grading ,the corrected TIMI framecount,the amplitude of ST segment in 90 minutes after PCI and the clinical prognosis were observed .Results The TIMIⅢ,CTFC,TMPGⅢ,the am-plitude of ST segment in 90 minutes and the LVEF after a month of the treatment group was better than the control group (P<0.05).The hemorrhage event and major adverse cardiovascular event (MACE) were similar in the two groups(P>0.05).Conclusion The intracoro-nary injection to patients with ST-elevation myocardial infarction (STEMI)on the basis of intravenous injection of tirofiban before pecutaneou coronary intervention(PCI) can promote the TIMI grading and the TMPG grading ,improve the myocardial ischemia reperfusion and the clini-cal prognosis.