CAJ | 학술논문

目的：评价在急性ST段抬高型心肌梗死（STEMI）患者直接经皮冠状动脉介入治疗（PCI）中联合应用血栓抽吸和经指引导管梗死相关动脉内注射替罗非班的有效性和安全性。方法选取100例STEMI患者，观察组为血栓抽吸＋替罗非班组（50例），血栓抽吸后3 min内经指引导管梗死相关动脉内注射替罗非班500μg并植入支架，后静脉滴入替罗非班[0.1μg/（kg·min）]12 h；对照组为单纯血栓抽吸组（50例）。观察两组术前TIMI血流分级、MBG分级，术后TIMI血流分级及MBG分级增加值、手术时间以及ST段完全回落率、CK-MB和TnT峰值、左心室射血分数、临床终点事件和出血事件。结果治疗后观察组TIMI血流分级及MBG分级增加值较对照组明显改善（P＜0.05）；术后心电图ST段完全回落率、PCI治疗后16 h及3个月超声心动图LVEF值显著高于对照组（P＜0.05）；CK-MB和TNT峰值明显低于对照组（P＜0.05）。观察组在临床终点事件总发生率方面明显低于对照组（P＜0.05），而两组在出血并发症方面差异无统计学意义。结论PCI联合应用血栓抽吸和经指引导管在梗死相关动脉内应用替罗非班可以改善心肌灌注，安全有效。
목적：평개재급성ST단태고형심기경사（STEMI）환자직접경피관상동맥개입치료（PCI）중연합응용혈전추흡화경지인도관경사상관동맥내주사체라비반적유효성화안전성。방법선취100례STEMI환자，관찰조위혈전추흡＋체라비반조（50례），혈전추흡후3 min내경지인도관경사상관동맥내주사체라비반500μg병식입지가，후정맥적입체라비반[0.1μg/（kg·min）]12 h；대조조위단순혈전추흡조（50례）。관찰량조술전TIMI혈류분급、MBG분급，술후TIMI혈류분급급MBG분급증가치、수술시간이급ST단완전회락솔、CK-MB화TnT봉치、좌심실사혈분수、림상종점사건화출혈사건。결과치료후관찰조TIMI혈류분급급MBG분급증가치교대조조명현개선（P＜0.05）；술후심전도ST단완전회락솔、PCI치료후16 h급3개월초성심동도LVEF치현저고우대조조（P＜0.05）；CK-MB화TNT봉치명현저우대조조（P＜0.05）。관찰조재림상종점사건총발생솔방면명현저우대조조（P＜0.05），이량조재출혈병발증방면차이무통계학의의。결론PCI연합응용혈전추흡화경지인도관재경사상관동맥내응용체라비반가이개선심기관주，안전유효。
Objective To evaluate the ST segment elevation myocardial infarction(STEMI)patients undergoing percutaneous coronary intervention directly therapy(PCI)in combination thrombus aspiration and the infarct-related artery via a suction catheter for injection tirofiban efficacy and safety. Methods 100 cases STEMI hospital patients were chosen.The observation group was gave thrombus aspiration+tirofiban group(50 cases), thrombus aspiration within 3 min after the infarct-related artery via a suction catheter injection of 500μg tirofiban and stenting , after intravenous non-drip classes(0.1μg/kg·min)12 h;the control group was simply thrombus aspiration group(50 cases), observed before surgery TIMI flow grade , MBG increased grading, grading and MBG after TIMI classification value, the operation time and the rate of complete ST-segment, CK-MB and TnT peak, left ventricular ejection fraction, end events and bleeding events. Results After treatment, the observation group TIMI flow grade and MBG added value improved significantly(P < 0.05);postoperative ST segment completely fall rate, 16h and 3month after PCI treatment echocardiography LVEF was significantly higher(P<0.05);CK-MB and TnT peak was significantly lower than the control group(P<0.05);in clinical endpoint event total incidence of observation group was obviously lower than the control group(P<0.05), and two groups had no statistically significant difference in bleeding complications. Conclusion Joint direct PCI thrombus aspiration and suction catheter through the infarct-related artery in select applications tirofiban can safely and effectively improve myocardial perfusion.