CAJ | 학술논문

目的探讨急诊经皮冠状动脉介入治疗(PCI)时,经血栓抽吸导管冠状动脉内注射替罗非班和硝普钠对重度血栓负荷前壁急性心肌梗死患者心肌组织水平灌注和临床预后的影响.方法连续入选急诊冠状动脉造影后提示靶病变为重度血栓负荷的前壁急性心肌梗死患者90例,年龄(59.8±11.5)岁.急诊PCI时,采用随机数字表法将患者随机分为单纯血栓抽吸组(A组,30例)、血栓抽吸联合冠状动脉内注射替罗非班组(B组,30例)和血栓抽吸联合冠状动脉内注射替罗非班和硝普钠组(C组,30例).比较3组患者的基线资料、手术前后的冠状动脉造影结果、住院以及随访期间主要不良心血管事件的发生情况.结果 3组患者的基线临床资料和冠状动脉造影资料差异均无统计学意义(P均＞0.05).胸痛至球囊扩张时间为(5.5±3.8)h.术后心肌梗死溶栓试验心肌灌注(TMP)分级＜3级的比例C组低于A和B组[10.0％(3/30)比40.0％ (12/30)、33.3％ (10/30),P分别＜0.01和0.05].术后5～7d左心室射血分数C组有优于A和B组的趋势,但差异无统计学意义(P=0.05).A组有1例患者在术后第7天因心力衰竭死亡,B和C组均无死亡事件.术后30 d,3组患者均未发生再发心肌梗死及靶血管血运重建事件.3组患者术后出血的比例差异无统计学意义(P＞0.05).结论对于行急诊PCI的重度血栓负荷前壁急性心肌梗死患者,血栓抽吸联合替罗非班和硝普钠冠状动脉内注射与单纯血栓抽吸相比,可以获得更好的心肌水平再灌注,且不增加出血及其他不良心血管事件.
목적 탐토급진경피관상동맥개입치료(PCI)시,경혈전추흡도관관상동맥내주사체라비반화초보납대중도혈전부하전벽급성심기경사환자심기조직수평관주화림상예후적영향.방법 련속입선급진관상동맥조영후제시파병변위중도혈전부하적전벽급성심기경사환자90례,년령(59.8±11.5)세.급진PCI시,채용수궤수자표법장환자수궤분위단순혈전추흡조(A조,30례)、혈전추흡연합관상동맥내주사체라비반조(B조,30례)화혈전추흡연합관상동맥내주사체라비반화초보납조(C조,30례).비교3조환자적기선자료、수술전후적관상동맥조영결과、주원이급수방기간주요불양심혈관사건적발생정황.결과 3조환자적기선림상자료화관상동맥조영자료차이균무통계학의의(P균＞0.05).흉통지구낭확장시간위(5.5±3.8)h.술후심기경사용전시험심기관주(TMP)분급＜3급적비례C조저우A화B조[10.0％(3/30)비40.0％ (12/30)、33.3％ (10/30),P분별＜0.01화0.05].술후5～7d좌심실사혈분수C조유우우A화B조적추세,단차이무통계학의의(P=0.05).A조유1례환자재술후제7천인심력쇠갈사망,B화C조균무사망사건.술후30 d,3조환자균미발생재발심기경사급파혈관혈운중건사건.3조환자술후출혈적비례차이무통계학의의(P＞0.05).결론 대우행급진PCI적중도혈전부하전벽급성심기경사환자,혈전추흡연합체라비반화초보납관상동맥내주사여단순혈전추흡상비,가이획득경호적심기수평재관주,차불증가출혈급기타불양심혈관사건.
Objective To explore the impact of intracoronary bolus administration of tirofiban combined with nitroprusside through thrombus aspiration catheter or thrombus aspiration alone on myocardial reperfusion and major adverse cardiovascular events rate in acute anterior myocardial infarction patients with heavy thrombosis burden.Methods Ninety consecutive acute anterior myocardial infarction patients with heavy thrombosis burden [(59.8 ± 11.5) years old] were randomly assigned to thrombus aspiration group (Group A,n =30),thrombus aspiration and intracoronary tirofiban bolus (25 μg/kg prior to the first balloon inflation,Group B,n =30),thrombus aspiration and intracoronary tirofiban combined with nitroprusside bolus (200 μg prior to the first balloon inflation,Group C,n =30) with random number table.Baseline clinical data,angiographic features before and after percutaneous coronary intervention (PCI) and major adverse cardiovascular events after PCI between 3 groups were compared.Results The baseline clinical data and angiographic features among 3 groups were similar (all P ＞ 0.05).The time of pain to balloon was (5.5 ± 3.8) hours.After primary PCI,myocardial tissue perfusion was significantly better in Group C than in Group A and Group B:TMP grade ＜ 3 [10.0％ (3/30)vs.40.0％ (12/30) and 33.3％ (10/30),P ＜0.01 and P ＜ 0.05].Left ventricular ejection fraction at 5 to 7 days after PCI also tended higher in Group C than in the other 2 groups (P =0.05).One patient died of heart failure at 7th day after PCI in Group A,and no patient died in Group B and C.Thirty days after PCI,there was no re-myocardial infarction and target vessel revascularization event among 3 groups.The bleeding complication rate during 30 days follow-up was similar among 3 groups (P ＞ 0.05).Conclusion Intracoronary bolus application of tirofiban combined with nitroprusside through thrombus aspiration catheter after thrombus aspiration is associated with an improvement of myocardial reperfusion without increasing bleeding complication and other adverse cardiovascular events rate compared with thrombus aspiration alone in patients with acute anterior myocardial infarction and heavy thrombosis burden undergoing primary PCI.