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Title:: Comparative study of noreflow at emergency percuteneous coronary intervention using diltiazem from microcatheter and from guiding catheter

作者:: 郑劲松¹; 2; 孟素荣²; 李群笑¹; 吴群英¹; 彭新辉²; 陈小林¹; 邹祎¹; (1.广东省江门市人民医院心内科，广东江门529050；2.南方医科大学附属南方医院心内科，广东广州 510515)

Author(s):: ZHENG Jing song¹; 2; MENG Su rong²; LI Qun xiao¹; WU Qun ying¹; PENG Xin hui²; CHEN Xiao lin¹; ZOU Yi¹; (1.Department of Cardiology, People’s Hospital of Jiangmen, Jiangmen 529050, Guangdong, China; 2.Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China)

关键词:: 微导管; 导引导管; 无复流现象; 地尔硫卓; 急诊PCI

Keywords:: guiding catheter; microcatheter; noreflow phenomenon; diltiazem; emergency percuteneous coronary intervention

分类号:: R541.4

DOI:: -

文献标识码:: A

摘要:: 目的:观察急诊经皮冠状动脉介入治疗(PCI)术中出现无复流现象后，经微导管向远端血管床注射地尔硫卓的治疗效果。方法:选择PCI治疗中存在“无复流”现象的患者41例为研究对象，其中20例入选导引导管组，经导引导管冠状动脉内注射地尔硫卓2.0 mg；21例入选微导管组，经微导管注射地尔硫卓2.0 mg至靶病变远端：10 min后复查冠状动脉造影，观察两组患者首次和手术结束前末次造影图像，评定冠状动脉血流心肌梗死溶栓试验（thrombolysis in myocardial infarction,TIMI）分级及TIMI心肌组织灌注分级(TMPG)、1周内住院期间主要心脏不良事件(MACE)事件。结果：2组均可改善PCI治疗后的“无复流”现象。微导管组手术结束前末次造影TIMIⅢ级比例明显高于导引导管组[95%(20/21) vs. 40%(8/20),P<0.05]，而且手术结束前末次造影TIMI心肌组织灌注分级(TMPG)Ⅲ级亦较高(90% vs. 35%,P<0.05)，减少1周内住院期间MACE事件(5% vs. 30%,P<0.05)。结论:与经导引导管相比，经微导管注射地尔硫卓明显改善急诊PCI术中无复流现象。

Abstract:: AIM:To study the effect of intramicrocatheter diltiazem on noreflow phenomenon during pereutaneous coronary intervention (PCI) for acute myocardial infaretion (AMI). METHODS: A total of 41 patients with noreflow phenomenon during PCI were included in this study. Patients were divided into guiding catheter group (diltiazem 2 mg injection from guiding catheter to target coronary, n=20) and microcatheter group (diltiazem 2 mg injection from microcatheter to farend target lesions, n=21). Coronary angiography was rechecked 10 minutes after injection. Thrombolysis in myocardial infarction (TIMI) and TIMI myocardial perfusion grade (TMPG) of target coronary and oneweek MACE in hospital were assessed. RESULTS: Noreflow phenomenon was relieved in both groups. The patients treated with diltiazem from microcatheter were significantly higher than those treated with guiding catheter in the last contrastographic picture TIMI-3 flow degree (20 cases vs. 8 cases, P<0.05). The microcatheter group was found to have higher rate of TMPG-3 in the last contrastographic picture after drug being administered (20 cases vs. 7 cases, P<0.05) and statistical difference was observed in oneweek MACE in hospital between the two groups (1 case vs. 6 cases, P<0.05). CONCLUSION: Diltiazem injection from mirocatheter achieves a better effect than injection from guiding catheter on no-reflow phenomenon during PCI for AMI patients.

参考文献/References

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经两种导管注射地尔硫卓处理急诊PCI术中无复流现象的疗效比较

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

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