CAJ | 학술논문

目的：观察经改制球囊导管冠脉内注射维拉帕米治疗无复流及慢血流的临床疗效。方法选取2009年1月~2015年1月于江苏大学附属昆山医院心内科接受PCI术中发生无复流及慢血流的急性冠脉综合征患者49例，其中男性37例，女性12例。分为单纯经指引导管在冠状动脉（冠脉）内注射维拉帕米的对照组（24例）和经改制球囊导管冠脉内注射维拉帕米的实验组（25例）。比较两组TIMI血流分级及校正TIMI帧数（CTFC）的变化，同时观察患者住院期间主要不良心血管事件发生情况。结果实验组和对照组治疗后血流TIMI分级和校正TIMI帧数均较治疗前改善，差异有统计学意义（P均＜0.05）。与对照组治疗后比较，实验组血流TIMI分级增加，校正TIMI帧数减少，为[（2.23±0.91）级 vs.（2.74±0.36）级]和[（19.30±17.90）帧vs.（13.70±7.10）帧]，差异有统计学意义（P均＜0.05）。住院期间对照组发生心力衰竭8例（33.3%）、恶性心律失常7例（29.2%）、心源性死亡1例；实验组发生心力衰竭2例（8.0%）、恶性心律失常1例（4.0%）。对照组较实验组主要不良心血管事件发生率增加（66.7% vs.12%），差异有统计学意义（P均＜0.05）。结论经改制球囊导管冠脉内远端注射维拉帕米较单纯经指引导管途径能改善冠脉血流，并能减少主要不良心血管事件的发生。
목적：관찰경개제구낭도관관맥내주사유랍파미치료무복류급만혈류적림상료효。방법선취2009년1월~2015년1월우강소대학부속곤산의원심내과접수PCI술중발생무복류급만혈류적급성관맥종합정환자49례，기중남성37례，녀성12례。분위단순경지인도관재관상동맥（관맥）내주사유랍파미적대조조（24례）화경개제구낭도관관맥내주사유랍파미적실험조（25례）。비교량조TIMI혈류분급급교정TIMI정수（CTFC）적변화，동시관찰환자주원기간주요불양심혈관사건발생정황。결과실험조화대조조치료후혈류TIMI분급화교정TIMI정수균교치료전개선，차이유통계학의의（P균＜0.05）。여대조조치료후비교，실험조혈류TIMI분급증가，교정TIMI정수감소，위[（2.23±0.91）급 vs.（2.74±0.36）급]화[（19.30±17.90）정vs.（13.70±7.10）정]，차이유통계학의의（P균＜0.05）。주원기간대조조발생심력쇠갈8례（33.3%）、악성심률실상7례（29.2%）、심원성사망1례；실험조발생심력쇠갈2례（8.0%）、악성심률실상1례（4.0%）。대조조교실험조주요불양심혈관사건발생솔증가（66.7% vs.12%），차이유통계학의의（P균＜0.05）。결론경개제구낭도관관맥내원단주사유랍파미교단순경지인도관도경능개선관맥혈류，병능감소주요불양심혈관사건적발생。
Objective To observe the curative effects of intracoronary injection of verapamil on coronary no-reflow and slow flow through restructured balloon catheter. Methods The patients with acute coronary syndrome (ACS, n=49, male 37 and female 12) and coronary no-reflow or slow flow during undergone PCI were chosen from Jan. 2009 to Jan. 2015, and then divided into control group (n=24, given intracoronary injection of verapamil through single guiding catheter) and test group (n=25, given intracoronary injection of verapamil through restructured balloon catheter). The changes of TIMI flow grading and corrected TIMI frame count (CTFC) were compared between 2 groups, and incidence of major adverse cardiovascular events (MACE) were observed in patients during hospital stay. Results TIMI flow grading and CTFC were improved all in 2 groups after treatment (all P<0.05). After treatment, TIMI flow grading increased and CTFC decreased in test group compared with control group [(2.23±0.91) vs. (2.74±0.36)], [(19.30±17.90) vs. (13.70±7.10), all P<0.05]. There were 8 cases (33.3%) with heart failure, 7 (29.2%) with malignant arrhythmia, and 1 with cardiac death in control group, and 2 (8.0%) with heart failure and 1 (4.0%) with malignant arrhythmia in test group. The incidence of MACE increased in control group compared with test group (66.7%vs. 12%, all P<0.05). Conclusion Intracoronary injection of verapamil through restructured balloon catheter can improve coronary blood flow and reduce the incidence of MACE compared with intracoronary injection of verapamil through single guiding catheter.