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目的:评价血栓抽吸联合冠状动脉内注射替罗非班,在急性ST段抬高性心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)中的疗效。方法:回顾性分析急性STEMI行直接PCI术患者124例,术中使用血栓抽吸联合冠状动脉内推注替罗非班的56例患者做为观察组,以同期行常规直接PCI术的STEMI患者68例做为对照组。评估PCI术后即刻心肌梗死溶栓试验(TIMI)血流分级、TIMI心肌组织灌注分级(TMPG)及矫正的TIMI帧数(cTFC)、PCI术中无复流的发生率、直接支架置入率、PCI术后90min完全ST段回落率、肌酸激酶同工酶(CK-MB)和肌钙蛋白T(TnT)峰值、PCI术后7d左心室射血分数(LVEF)、住院期间和PCI术后3个月内主要心脏不良事件(MACE)发生率。结果:与对照组比较,观察组PCI术后即刻TIMI 3级及TMPG 3级血流比例更高(分别为94.6%∶80.9%,91.1%∶73.5%,P<0.05);cTFC帧数更少[(44.1±16.7)帧∶(57.1±23.1)帧,P<0.01];无复流发生率低(5.4%∶19.1%,P<0.05);直接支架置入率高(21.4%∶8.8%,P<0.05);PCI术后90min完全ST段回落率高(85.7%∶67.6%,P<0.05);CK-MB和TnT峰值低[分别为(172.4±45.6)U/L∶(201.7±39.5)U/L,(5.46±1.82)ng/L∶(6.59±1.97)ng/L,P<0.01];PCI术后7dLVEF高[(56.3±7.8)%∶(52.7±6.8)%,P<0.01]。观察组住院期间MACE少于对照组(14.3%∶26.5%),但差异无统计学意义,而PCI术后3个月内MACE亦少于对照组(26.8%∶44.1%),且差异有统计学意义(P<0.05)。结论:血栓抽吸联合冠状动脉内注射替罗非班可以增加急性STEMI患者直接PCI术中的冠状动脉血流和心肌组织灌注,减少无复流发生,减少心肌坏死,改善心功能和预后。
Objective: To evaluate the efficacy of thrombus aspiration combined with intracoronary injection of tirofiban for percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: A total of 124 patients with acute STEMI undergoing direct PCI were retrospectively analyzed. Fifty-six patients with thrombus aspiration and intracoronary bolus injection of tirofiban were enrolled in the study. Patients in STEMI group undergoing routine direct PCI 68 cases as a control group. TIMI flow grade, TIMI myocardial perfusion grade (TMPG) and corrected TIMI frame number (cTFC), incidence of no-reflow in PCI, direct stent implantation rate , The complete ST segment resolution 90 minutes after PCI, the peak values of CK-MB and TnT, left ventricular ejection fraction (LVEF) at 7 days after PCI, hospitalization and PCI The incidence of major cardiac adverse events (MACE) within the last 3 months. Results: Compared with the control group, TIMI grade 3 and TMPG grade 3 blood flow rate was significantly higher in the observation group after PCI (94.6%, 80.9%, 91.1%, 73.5%, P <0.05, respectively) and fewer cTFC frames (44.1 ± 16.7) frames: (57.1 ± 23.1) frames, P <0.01]. The incidence of no-reflow was low (5.4% vs 19.1%, P < , P <0.05). The rate of complete ST segment recovery 90 minutes after PCI was high (85.7% vs 67.6%, P <0.05), and the peak values of CK-MB and TnT were (172.4 ± 45.6) U / L (56.3 ± 7.8)% (52.7 ± 6.8)%, P (P <0.01); P (P <0.01) <0.01]. The MACE in the observation group was less than that in the control group (14.3%, 26.5%) during the hospitalization period, but the difference was not statistically significant. The MACE in the observation group was also less than that in the control group (26.8% and 44.1% Significance (P <0.05). Conclusion: Thrombus aspiration combined with intracoronary injection of tirofiban can increase coronary blood flow and myocardial perfusion in patients with acute STEMI during PCI, reduce the occurrence of no-reflow, reduce myocardial necrosis and improve cardiac function and prognosis.