CAJ | 학술논문

目的观察冠状动脉内注射替罗非班预防急诊经皮冠状动脉介入治疗(PCI)术中无复流的临床疗效. 方法选择我院ST段抬高型急性心肌梗死(STEMI)接受急诊PCI患者99例,随机分为试验组(冠脉内注射替罗非班后行PCI) 50例和对照组(常规行单纯PCI)49例.收集所有病例的临床资料和冠脉造影资料,对比两组患者PCI术中无复流的发生率、冠状动脉狭窄程度分级(TIMI)血流分级、矫正的帧计数(CTFC)、出血并发症、术后30d主要心脏不良事件(MACE). 结果试验组PCI术中 3级TIMI患者例数、CTFC分别为45例和(21.3±6.7)帧数,均优于对照组31例和(37.6±7.2)帧数(P＜0.05),试验组无复流的发生率明显小于对照组;出血事件轻度增加但差异无统计学意义,MACE试验组发生率为8％,少于对照组的18.4％(P＜0.05). 结论急诊PCI前冠状动脉内缓慢注射盐酸替罗非班可以明显改善急性STEMI患者急诊PCI术中持久的开通梗死相关动脉远端的前向血流,降低无复流现象的发生率,安全性好,疗效确切.
목적 관찰관상동맥내주사체라비반예방급진경피관상동맥개입치료(PCI)술중무복류적림상료효. 방법 선택아원ST단태고형급성심기경사(STEMI)접수급진PCI환자99례,수궤분위시험조(관맥내주사체라비반후행PCI) 50례화대조조(상규행단순PCI)49례.수집소유병례적림상자료화관맥조영자료,대비량조환자PCI술중무복류적발생솔、관상동맥협착정도분급(TIMI)혈류분급、교정적정계수(CTFC)、출혈병발증、술후30d주요심장불량사건(MACE). 결과 시험조PCI술중 3급TIMI환자례수、CTFC분별위45례화(21.3±6.7)정수,균우우대조조31례화(37.6±7.2)정수(P＜0.05),시험조무복류적발생솔명현소우대조조;출혈사건경도증가단차이무통계학의의,MACE시험조발생솔위8％,소우대조조적18.4％(P＜0.05). 결론 급진PCI전관상동맥내완만주사염산체라비반가이명현개선급성STEMI환자급진PCI술중지구적개통경사상관동맥원단적전향혈류,강저무복류현상적발생솔,안전성호,료효학절.
Objective To assess the effects of intracoronary tirofiban on preventing no-reflow during emergency percutaneous coronary intervention(PCI).Methods All 99 cases with acute myocardial infarction who underwent emergency PCI between March 2009 and March 2012 were randomized into test group of intracoronary bolus administration of tirofiban (n=50) and group of control (n =49).The clinical characteristics and the result of coronarography were observed.Thrombolysis in myocardial infarction (TIMI) flow grade,and corrected TIMI frame count (cTFC) of the two groups were compared.Incidence of 30 days follow-up major adverse cardiac events(MACE) and major bleeding events were also observed in both groups.Results Compared with control group,tirofiban treated group showed significantly more patients higher TIMI-3 flow (P＜0.05).cTFC was decreased in tirofiban treated group (21.3 ± 6.7) as compared to control group (37.6 +7.2),(P＜0.05).The incidence of no-reflow in tirofiban treated group was lower than in control.The incidence of major bleeding events were the same among two groups,while the incidence of 30 days follow-up MACE in tirofiban treared group (8％) was reduced compared with control group (18.4 ％),(P＜ 0.05).Conclusions Intracoronary tirofiban prior to emergency PCI is safe and effective for the patients with acute STEMI.It might lead to improved TIMI flow and myocardial reperfusion.