我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

冠脉内注射高剂量替罗非班对急性ST段抬高型心肌梗死直接PCI术后碎裂QRS波的影响

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2017年第5期
页码:
563-566
栏目:
临床研究
出版日期:
2017-03-25

文章信息/Info

Title:
Effect of intracoronary injection of high-dose tirofiban on fragmented QRS complexes in patients with acute ST segment elevation myocardial infarction after primary percutaneous coronary intervention
作者:
王学忠; 王岳松; 汪韶君; 樊 琴; 邵旭武; 夏金发; 方永华
（马鞍山市人民医院心内科，安徽 马鞍山243000)
Author(s):
WANG Xue-zhong;  WANG Yue-song;  WANG Shao-jun;  FAN Qin;  SHAO Xu-wu;  XIA Jin-fa;  FANG Yong-hua
(Department of Cardiology, Ma’anshan People’s Hospital, Ma’anshan 243000, Anhui, China)
关键词:
替罗非班;  冠状动脉内注射; 碎裂QRS波; 直接PCI
Keywords:
tirofiban;  intracoronary injection;  fragmented QRS complexes;  primary percutaneous coronary intervention
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 探讨冠脉内注射高剂量替罗非班对急性ST段抬高型心肌梗死（STEMI）直接经皮冠状动脉介入（PCI）治疗术后体表心电图出现碎裂QRS波（fQRS）的影响。方法 连续入选150例接受直接PCI治疗的急性STEMI患者，随机分成冠脉内注射高剂量替罗非班组（替罗非班组，n=75）和常规治疗组（n=75），观察住院48 h内体表心电图fQRS的发生率以及术后住院期间主要不良心脏事件（MACE）。结果 两组临床基本特征无显著差别。替罗非班组术后校正的TIMI帧数(CTFC)较常规组少〔（23± 7）帧 vs.（30± 10）帧，P<0.05〕;肌酸激酶同工酶（CK-MB）峰值浓度显著低于常规治疗组〔（245±162）U/L vs.（311±180）U/L，P<0.05〕，而左心室射血分数 (LVEF）值则显著高于常规治疗组〔（51±6）% vs.（47±7）%，P<0.05〕，同时，术后替罗非班组和常规治疗组fQRS发生率分别41%(30/75)和57%(43/75)，两组之间比较差异显著，P<0.05）。两组住院期间MACE事件有差异，但未达到统计学意义（5% vs. 12%）。结论 冠脉注射高剂量替罗非班能改善心肌灌注，降低术后体表心电图fQRS发生率，提高心脏功能。
Abstract:
AIM To investigate the effect of intracoronary injection high-dose tirofibann on the fragmented QRS complexes (fQRS) in patients with acute ST segment elevation myocardial infarction (STEM) after primary percutaneous coronary intervention (PCI). METHODS One hundred fifty acute STEMI patients enrolled continuously in the study were divided into high-dose tirofiban group (tirofiban group) and routine treatment group (routine group). The changes of fQRS on electrocardiogram and the MACE events were observed within 48 hours after primary PCI. RESULTS A total of 150 patients (aged 35-83 years; male, 82.7%) were included in the study and the baseline clinical characteristics were comparable between the two groups. Compared with patients in routine group, patients in the tirofiban group had lower levels of creatine kinase-MB ［(245±162) U/L vs. (311±180) U/L, P<0.05］ and corrected TIMI Frame Count (CTFC) post-PCI ［(23±7) vs. (30±10), P<0.05］, but higher left ventricular ejection fraction (LVEF) ［(51±6)% vs. (47±7)%, P<0.05］. The incidence of presence of fQRS on electrocardiogram in tirofiban group was lower than that in routine group (41% (30/75) vs. 57% (43/75), P<0.05). In Spearman’s correlation analysis, the level of CK-MB showed positive correlation with the number of leads with fQRS (r=0.207, P<0.05), but LVEF showed negative correlation with the number of leads with fQRS (r=-0.242, P<0.01). Multivariate analysis revealed that the intracoronary injection of high-dose tirofiban was the negative predictor of fQRS (Wald=4.257, OR: 0.364, 95% CI 0.139-0.95, P<0.05). There were differences in MACE events between the two groups during hospitalization, but the differences were not statistically significant (5.3% to 12%. t=3.63). CONCLUSION High-dose intracoronary injection of tirofiban can help to improve myocardial perfusion, reduce postoperative the presence of fQRS appearing on the standard 12-lead ECG and enhance cardiac functions.

参考文献/References

[1]Xu Y,Qiu Z,Xu Y,et al.The role of fQRS in coronary artery disease. A meta-analysis of observational studies[J]. Herz,2015,40(Suppl 1):8-15.
[2]Ma X,Duan W,Poudel P,et al.Fragmented QRS complexes have predictive value of imperfect ST-segment resolution in patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention[J].Am J Emerg Med,2016,34(3):398-402.
[3]Tanriverdi Z,Dursun H,Kaya D.The Importance of the Number of Leads with fQRS for Predicting In-Hospital Mortality in Acute STEMI Patients Treated with Primary PCI[J].Ann Noninvasive Electrocardiol,2016,21(4):413-419.
[4]Zhu TQ,Zhang Q,Qiu JP,et al.Beneficial effects of intracoronary tirofiban bolus administration following upstream intravenous treatment in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: the ICT-AMI study[J].Int J Cardiol,2013,165(3):437-443.
[5]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2010,38(8):675-687.
[6]Kushner FG,Hand M,Smith SC Jr,et al.2009 Focused Updates:ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction(updating the 2004 Guideline and 2007 Focused Update)and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention(updating the 2005 Guideline and 2007 Focused Update):a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].Circulation,2009,120(22):2271-2306.
[7]Gibson CM,Cannon CP,Daley WL,et al.TIMI Frame Count:a quantitative method of assessing coronary artery flow[J].Circulation,1996,93(5):879-888.
[8]王学忠,王岳松,邵旭武,等.碎裂QRS波在急性心肌梗死经皮冠状动脉介入治疗术后再发主要心脏不良事件中的预后价值[J].中华急诊医学杂志,2014,23(7):746-751.
[9]Jain R,Singh R,Yamini S,et al.Fragmented ECG as a risk marker in cardiovascular diseases[J].Curr Cardiol Rev,2014,10(3):277-286.
[10]Das MK,Michael MA,Suradi H,et al.Usefulness of fragmented QRS on a12-lead electrocardiogram in acute coronary syndrome for predicting mortality[J].Am J Cardiol,2009,104(12):1631-1637.
[11]Erdem FH,Tavil Y,Yazici H,et al.Association of fragmented QRS complex with myocardial reperfusion in acute ST-elevated myocardial infarction[J].Ann Noninvasive Electrocardiol,2013,18(1):69-74.
[12]Ozcan F,Turak O,Canpolat U,et al.Myocardial tissue perfusion predicts the evolution of fragmented QRS in patients with ST-segment elevationmyocardial infarction undergoing primary percutaneous coronary intervention[J].Ann Noninvasive Electrocardiol,2014,19(5):454-461.
[13]Ari H,Cetinkaya S,Ari S,et al.The prognostic significance of a fragmented QRS complex after primary percutaneous coronary intervention[J].Heart Vessels,2012,27(1):20-28.
[14]Friedland S,Eisenberg MJ,Shimony A.Meta-analysis of randomized controlled trials of intracoronary versus intravenous administration of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention for acute coronary syndrome[J].Am J Cardiol,2011,108(9):1244-1251.
[15]Topol EJ,Moliterno DJ,Herrmann HC,et al.Comparison of two platelet glycoprotein IIb/IIIa inhibitors, tirofiban and abciximab, for the prevention of ischemic events with percutaneous coronary revascularization[J].N Engl J Med,2001,344(25):1888-1894.
[16]Bilsel T,Akbulut T,Yesilcimen K,et al.Single high-dose bolus tirofiban with high-loading-dose clopidogrel in primary coronary angioplasty[J].Heart Vessels,2006,21(2):102-107.
[17]Sun Z,Zeng J,Huang H.Intracoronary injection of tirofiban prevents microcirculation dysfunction during delayed percutaneous coronary intervention in patients with acute myocardial infarction[J].Int J Cardiol,2016,208:137-140.
[18]任晓楠,王乐丰,王明生,等.早期应用大剂量替罗非班对急性ST段抬高型心肌梗死患者急诊介入术后血小板聚集功能及活性的影响[J].中华心血管病杂志,2012,40(2):131-135.

备注/Memo

备注/Memo:
收稿日期：2016-05-26.
作者简介：王学忠，副主任医师，博士 Email：wxz27006@126.com
更新日期/Last Update: 2017-04-20