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血栓抽吸联合冠状动脉内注射替罗非班对急性ST段抬高型心肌梗死患者的疗效观察

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2015年第4期
页码:
440-443
栏目:
临床研究
出版日期:
2015-04-20

文章信息/Info

Title:
Effect of intracoronary tirofiban and thrombus aspiration on patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention
作者:
曹艳杰1; 刘 毅1; 马彦卓2; 周景昱1; 栾荣华1; 王海昌1
(1.第四军医大学西京医院心血管内科，陕西 西安 710032；
2.白求恩国际和平医院心血管内科，河北 石家庄 050000)
Author(s):
CAO Yan-jie1;  LIU Yi1;  MA Yan-zhuo2;  ZHOU Jing-yu1;  LUAN Rong-hua1;  WANG Hai-chang1
(1.Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, Shaanxi, China；
2.Department of Cardiology, Bethune International Peace Hospital, Shijiazhuang 050000, Hebei, China)
关键词:
心肌梗死; 急性; 血栓抽吸; 替罗非班
Keywords:
ST-elevation myocardial infarction;  thrombus aspiration;  tirofiban
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 观察冠脉内注射替罗非班联合血栓抽吸在急性ST段抬高型心肌梗死(STEMI)患者中的疗效。方法 选择2009年~2012年诊断为STEMI接受直接经皮冠状动脉介入(PCI)治疗的240例患者，随机分为直接PCI组、冠脉内注射替罗非班组（替罗非班组）、血栓抽吸组和血栓抽吸联合冠脉内注射替罗非班组（联合治疗组)。观察4组术后冠状动脉TIMI血流分级、心肌染色分级、术后24 h ST段回落>70%比率，术后6个月的主要复合终点事件。结果 与直接PCI组相比，血栓抽吸组、联合治疗组TIMI血流分级增加（P<0.05，P<0.01）;替罗非班组、联合治疗组心肌染色增加(均P<0.05)；血栓抽吸组、联合治疗组ST段回落>70%比率增加(P<0.05，P<0.01)；替罗非班组不降低患者6个月主要复合终点事件，血栓抽吸组降低患者6个月主要复合终点事件。但是，与替罗非班组或血栓抽吸组相比，联合治疗组在TIMI血流分级、心肌染色分级、术后24 h ST段回落>70%比率、6个月主要复合终点事件均未改善；4组间出血事件无显著差异。结论 血栓抽吸能改善急性ST段抬高型心肌梗死患者心肌灌注及降低6个月主要复合终点事件。
Abstract:
AIM To evaluate the effect of intracoronary tirofiban and manual thrombus aspiration on patients with ST-elevation myocardial infarction (STEMI). METHODS The study enrolled 240 consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI). The patients were divided into four groups: primary PCI group, intracoronary tirofiban group, thrombus aspiration group and combined treatment group of intracoronary tirofiban and thrombus aspiration. Myocardial reperfusion and 6-month major adverse cardiac events were assessed. RESULTS Compared with primary PCI group, myocardial blush grades (MBG) 2-3 were more frequent in treatment groups and much higher in combined treatment group. TIMI flow grade 3 and complete ST-segment resolution were significantly increased in thrombus aspiration group and combined treatment group and were much higher in combined treatment group than those in thrombus aspiration group, although the p value was not significant. Major adverse cardiac events were reduced in the thrombus aspiration group at 6-month follow up. CONCLUSION Myocardial reperfusion and clinical outcomes are improved in thrombus aspiration group. However, combined treatment of intracoronary tirofiban and thrombus aspiration does not improve myocardial reperfusion and clinical outcomes.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2014-07-15.
通讯作者：王海昌，主任医师，主要从事冠心病基础及临床研究 Email:wanghc@fmmu.edu.cn
作者简介：曹艳杰，副主任医师，博士 Email:caoyanjie@fmmu.edu.cn
更新日期/Last Update: 2015-04-22