CAJ | 학술논문

目的：评价血栓抽吸导管联合替罗非班开通急性ST段抬高型心肌梗死(STEMI）患者梗死相关动脉对恢复心肌“再灌注”的近期临床疗效。 　　方法：选择2011-05至2013-05在我院急诊行经皮冠状动脉介入治疗（PCI）的STEMI患者105例，其中男性73例，女性32例，平均年龄58.39±10.37（35~83）岁。将患者随机分为两组，应用血栓抽吸导管联合经冠状动脉内注射替罗非班的53例患者为A组，单独使用替罗非班而行PCI的52例患者为B组，比较两组间的临床基础资料特征、心肌组织灌注水平、术后住院期间和随访6个月的主要心血管事件、术后6个月超声心动图检查测定的心功能。 　　结果：两组间的临床基础资料差异无统计学意义。A组术后心肌梗死溶栓治疗临床试验（TIMI）3级血流发生率显著高于B组（92.45%vs 55.77%，P<0.001），A组TIMI2级、TIMI0~1级的发生率显著低于B组（7.55%vs 26.92%， P=0.008；0 vs 17.31%，P=0.002）；A组校正TIMI帧数低于B组[(27.26±5.50)帧vs（38.98±5.42）帧，P<0.001]；术后6个月A组超声心动图检查测定的左心室射血分数大于B组[（0.55±0.06）vs（0.47±0.06），P<0.001]，左心室舒张末期内径小于B组[（50.77±5.45）mm vs（54.76±5.34）mm，P<0.001]；术后住院期间和随访6个月A组心绞痛和靶血管再次血运重建率低于B组（16.98%vs 40.38%，P=0.008；9.43%vs 17.31%，P=0.008），两组比较差异均有统计学意义。术后住院期间和随访6个月A组的心肌梗死发生率、急性心力衰竭发生率、心原性死亡发生率、非靶血管再次血运重建率均低于B组，但差异均无统计学意义（P>0.05）。 　　结论：在急诊PCI中血栓抽吸导管联合应用替罗非班可以显著改善STEMI患者心肌再灌注和PCI术后近期的心功能，降低无复流的发生率，不增加主要不良心血管事件发生率。
목적：평개혈전추흡도관연합체라비반개통급성ST단태고형심기경사(STEMI）환자경사상관동맥대회복심기“재관주”적근기림상료효。 　　방법：선택2011-05지2013-05재아원급진행경피관상동맥개입치료（PCI）적STEMI환자105례，기중남성73례，녀성32례，평균년령58.39±10.37（35~83）세。장환자수궤분위량조，응용혈전추흡도관연합경관상동맥내주사체라비반적53례환자위A조，단독사용체라비반이행PCI적52례환자위B조，비교량조간적림상기출자료특정、심기조직관주수평、술후주원기간화수방6개월적주요심혈관사건、술후6개월초성심동도검사측정적심공능。 　　결과：량조간적림상기출자료차이무통계학의의。A조술후심기경사용전치료림상시험（TIMI）3급혈류발생솔현저고우B조（92.45%vs 55.77%，P<0.001），A조TIMI2급、TIMI0~1급적발생솔현저저우B조（7.55%vs 26.92%， P=0.008；0 vs 17.31%，P=0.002）；A조교정TIMI정수저우B조[(27.26±5.50)정vs（38.98±5.42）정，P<0.001]；술후6개월A조초성심동도검사측정적좌심실사혈분수대우B조[（0.55±0.06）vs（0.47±0.06），P<0.001]，좌심실서장말기내경소우B조[（50.77±5.45）mm vs（54.76±5.34）mm，P<0.001]；술후주원기간화수방6개월A조심교통화파혈관재차혈운중건솔저우B조（16.98%vs 40.38%，P=0.008；9.43%vs 17.31%，P=0.008），량조비교차이균유통계학의의。술후주원기간화수방6개월A조적심기경사발생솔、급성심력쇠갈발생솔、심원성사망발생솔、비파혈관재차혈운중건솔균저우B조，단차이균무통계학의의（P>0.05）。 　　결론：재급진PCI중혈전추흡도관연합응용체라비반가이현저개선STEMI환자심기재관주화PCI술후근기적심공능，강저무복류적발생솔，불증가주요불양심혈관사건발생솔。
Objective: To evaluate the short-term effect of thrombus aspiration catheters combining tiroifban medication for myocardial tissue reperfusion recovery in patients with acute ST-elevation myocardial infarction (STEMI). Methods: A total of 105 STEMI patients with percutaneous coronary intervention (PCI) in our hospital from 2011-05 to 2013-05 were studied, there were 73 male and 32 female with the mean age of (58.39 ± 10.37) years. The patients were randomly divided into 2 groups, Group A, the patients received thrombus aspiration catheters with intravenous tiroifban, n=53 and Group B, the patients received tiroifban and PCI, n=52. The basic clinical features, myocardial tissue perfusion level, major adverse cardiovascular events (MACE) at post operative and in-hospital period were recorded, the cardiac function was examined by echocardiography at 6 months after PCI in both groups. Results: The basic clinical features were similar between 2 groups. The thrombolysis in myocardial infarction trial (TIMI) 3 lfow rate was higher in Group A than that in Group B (92.45% vs 55.77%), P=0.000. TIMI 2 and TIMI 0~1 lfow rates were lower in Group A than that in Group B (7.55%vs 26.92%), P=0.008 and (0%vs 17.31%), P=0.002. The adjusted TIMI frame was lower in Group A (27.26±5.50) vs (38.98±5.42), P<0.001. The echocardiography at 6 months after PCI indicated that Group A had higher LVEF than that in Group B (0.55±0.06) vs (0.47±0.06), P<0.001;lower left ventricular end diastolic diameter (50.77±5.45) vs (54.76±5.34), P<0.001;less angina and target vessel revascularization (16.98%vs 40.38%), P=0.008 and (9.43%vs 17.31%), P=0.008. The incidence of MI, acute heart failure, cardiac death and non-target vessel revascularization were similar between 2 groups, P>0.05. Conclusion:Thrombus aspiration catheters combining tiroifban medication may obviously improve the myocardial tissue reperfusion and the short-term cardiac function in STEMI patients after PCI, it could reduce the incidence of no-relfow without increasing MACE.