CAJ | 학술논문

目的观察急性心肌梗死(AMI)恢复期患者行经皮冠状动脉介入治疗(PCI)时应用血栓抽吸导管联合冠状动脉内注射替罗非班和硝酸甘油的疗效.方法收集2009年9月至2012年9月郑州大学第一附属医院心血管内科收治的AMI恢复期患者250例,采用随机数字表将患者分为2组:治疗组(n=130)采用血栓抽吸导管联合冠状动脉内注射替罗非班和硝酸甘油,对照组(n=120)采用常规PCI治疗.比较两组患者手术时间,术后即刻心肌梗死溶栓治疗(TIMI)血流分级和校正TIMI帧数(CTFC),术后2h心电图ST段50％回落情况,术后7d血清脑利钠肽(BNP)水平和大出血情况；术后3个月心脏彩超测量左室射血分数(LVEF)、左室舒张末期内径(LVEDd)、左室收缩末期内径(LVESd),同时记录主要不良心脏事件(MACE).结果治疗组与对照组手术时间差异无统计学意义[(50.76±10.53)min比(59.94±9.78)min,P＞0.05].与对照组比较,术后即刻治疗组患者TIMI 3级血流的比例增多(94.62％比85.00％,P＜0.05),CTFC明显减少[(27.68±6.97)帧/s比(38.98±5.42)帧/s,P＜0.05].两组患者术后2h心电图ST段50％的回落比例差异无统计学意义(64.62％比63.33％,P＞0.05).术后7d,治疗组血BNP水平低于对照组[(209.0±70.1)μg/L比(298.0±69.4) μg/L,P＜0.05],两组均无大出血患者.术后3个月心脏超声检查显示,与对照组比较,治疗组LVEF升高[(48.97±6.74)％比(39.42±9.56)％,P＜0.05],LVEDd减少[(47.58±5.94) mm比(50.46±6.78) mm,P＜0.05],LVESd减少[(24.76±3.21) mm比(26.84±3.67)mm,P＜0.05].随访3个月内,治疗组术后MACE发生率明显低于对照组(0.77％比3.33％,P＜0.05).结论 AMI恢复期患者行PCI过程中,应用血栓抽吸导管联合冠状动脉内注射替罗非班和硝酸甘油治疗效果明显.
목적 관찰급성심기경사(AMI)회복기환자행경피관상동맥개입치료(PCI)시응용혈전추흡도관연합관상동맥내주사체라비반화초산감유적료효.방법 수집2009년9월지2012년9월정주대학제일부속의원심혈관내과수치적AMI회복기환자250례,채용수궤수자표장환자분위2조:치료조(n=130)채용혈전추흡도관연합관상동맥내주사체라비반화초산감유,대조조(n=120)채용상규PCI치료.비교량조환자수술시간,술후즉각심기경사용전치료(TIMI)혈류분급화교정TIMI정수(CTFC),술후2h심전도ST단50％회락정황,술후7d혈청뇌리납태(BNP)수평화대출혈정황；술후3개월심장채초측량좌실사혈분수(LVEF)、좌실서장말기내경(LVEDd)、좌실수축말기내경(LVESd),동시기록주요불양심장사건(MACE).결과 치료조여대조조수술시간차이무통계학의의[(50.76±10.53)min비(59.94±9.78)min,P＞0.05].여대조조비교,술후즉각치료조환자TIMI 3급혈류적비례증다(94.62％비85.00％,P＜0.05),CTFC명현감소[(27.68±6.97)정/s비(38.98±5.42)정/s,P＜0.05].량조환자술후2h심전도ST단50％적회락비례차이무통계학의의(64.62％비63.33％,P＞0.05).술후7d,치료조혈BNP수평저우대조조[(209.0±70.1)μg/L비(298.0±69.4) μg/L,P＜0.05],량조균무대출혈환자.술후3개월심장초성검사현시,여대조조비교,치료조LVEF승고[(48.97±6.74)％비(39.42±9.56)％,P＜0.05],LVEDd감소[(47.58±5.94) mm비(50.46±6.78) mm,P＜0.05],LVESd감소[(24.76±3.21) mm비(26.84±3.67)mm,P＜0.05].수방3개월내,치료조술후MACE발생솔명현저우대조조(0.77％비3.33％,P＜0.05).결론 AMI회복기환자행PCI과정중,응용혈전추흡도관연합관상동맥내주사체라비반화초산감유치료효과명현.
Objective To determine the efficacy of thrombus aspiration catheterization and coronary injection of tirofiban and nitroglycerin via percutaneous coronary intervention (PCI) in patients during convalescent phase of acute myocardial infarction (AMI).Methods A total of 250 patients with AMI during convalescent phase admitted to The First Affiliated Hospital of Zhengzhou University,between September 2009 and September 2012,were randomly assigned to be treated with thrombus aspiration catheterization and coronary injection of tirofiban and nitroglycerin (treatment group,n=130) or conventional PCI (control group,n=120).Comparisons were made in a series of clinical indices,including the duration of surgery,grading of blood flow immediately after thrombolysis in myocardial infarction (TIMI),corrected TIMI frame count (CTFC),presence of 50％ reduction in ST segment 2 h postoperatively,postoperative levels of serum BNP and massive hemorrhage at day 7,left ventricular ejection fraction (LVEF),left ventricular end-diastolic diameter (LVEDd),left ventricular end-systolic diameter (LVESd) and major adverse cardiac events (MACE) 3 months after operation.Results The difference in the duration of operation was unremarkable between two groups [(50.76± 10.53) min vs (59.94 ± 9.78) min,P＞0.05].Compared with control group,the treatment group yielded an increased proportion of TIMI blood flow grading of 3 flow or more (94.62％ vs 85.00％,P＜0.05) and a significantly lower CTFC [(27.68±6.97) frame/s vs (38.98±5.42) frame/s,P＜0.05].There was no marked difference in the proportion of patients who evidenced a 50％ reduction in ST segment at 2 h postoperatively (64.62％ vs 63.33％,P＞0.05).The treatment group was associated with reduced levels of serum BNP at day 7 postoperatively compared with control group [(209.0±70.1) μg/L vs (298.0±69.4) μg/L,P＜0.05].No massive hemorrhage case was found in two groups.At 3-month following operation,echocardiography evidenced an increased LVEF [(48.97 ±6.74)％ vs (39.42±9.56)％,P＜0.05],reduced LVEDd [(47.58±5.94) mm vs (50.46±6.78) mm,P＜0.05] and reduced LVESd [(24.76±3.21) mm vs (26.84±3.67) mm,P＜0.05] in the treatment group.There was a significantly lower incidence of MACE in treatment group as compared with control group (0.77％ vs 3.33％,P＜0.05).Conclusion Treatment with thrombus aspiration catheterization and coronary injection of tirofiban and nitroglycerin via PCI is effective in patients during convalescent phase of AMI.