经微导管冠脉内注射替罗非斑治疗超高龄患者急性ST段抬高型心肌梗死的疗效-东南大学学报医学版

经微导管冠脉内注射替罗非斑治疗超高龄患者急性ST段抬高型心肌梗死的疗效

单位：南京医科大学附属南京医院(南京市第一医院) 心内科, 江苏南京 210006

分类号：R542.22

出版年·卷·期（页码）：2015·34·第六期（953-958）

摘要：

目的:探讨经微导管冠脉内应用替罗非斑在超高龄ST段抬高型心肌梗死(心梗)患者急诊行经皮冠状动脉介入治疗(PCI)中的疗效及安全性.方法:回顾性分析78例超高龄急性ST段抬高型心梗且经急诊冠脉造影证实梗死相关血管(IRA)、心肌梗死溶栓试验(TIMI)血栓积分在3分以上患者,分为经指引导管冠脉内注射替罗非斑治疗组(对照组,42例)和经微导管冠脉内注射替罗非斑治疗组(研究组,36例),比较两组行急诊PCI术后即刻TIMI血流分级、术后校正的TIMI血流计帧数、TIMI心肌灌注(TMPG)分级、术后90 min心电图sumSTR、住院期间和1年后随访时左室射血分数(LVEF)、出血发生率以及主要心脏不良事件(MACE)发生率有无差异.结果:研究组术后TIMI血流3级、TMPG 3级以及术后90 min心电图sumSTR≥70%发生率明显高于对照组,术后校正的TIMI血流计帧数研究组亦明显低于对照组,差异均有统计学意义(P<0.05),住院期间及1年后随访时研究组LVEF值高于对照组,差异有统计学意义(P<0.05),但两组患者出血及MACE发生率比较差异无统计学意义(P>0.05).结论:经微导管冠脉内注射替罗非斑治疗急性ST段抬高型心肌梗死老年患者能有效改善其术后即刻TIMI血流分级、心肌水平的灌注、住院期间及1年后左心功能,且治疗措施是安全的.

Objective: To evaluate the efficacy and safety of trans microcatheter intra-coronary injection of tirofiban followed by continuing intravenous infusion in octogenarians with acute myocardial infarction(AMI) undergoing emergency percutaneous coronary intervention(PCI). Methods: Retrospective analysis of 78 octogenarians with acute ST-segment elevation myocardial infarction whose TIMI thrombus score were more than 3 in their initial coronary angiography findings. They were divided into two groups according to the methods of administration for tirofiban.36 patients were enrolled in study group who were given tirofiban trans microcatheter during the procedure,and the other 42 patients who were given tirofiban through guiding catheter were in control group. The basic clinical data, TIMI thrombus score, TIMI flow grades, corrected TIMI frame count, TIMI myocardial perfusion grades(TMPG) before and after the procedure, and the resolution of the sum of ST-segment elevation (sumSTR) at 90 minutes, periprocedural bleeding events, major adverse cardiaovascular events(MACE) and left ventricular ejection fraction (LVEF)during hospitalizition and at one year follow up were all compared between the two groups. Results: No significant differences were found in basic clinical data, TIMI flow grades, TIMI frame count and TMPG before procedure and periprocedural bleeding events between the two groups (P>0.05),so were MACE during hospitalization and at one year follow up. But the study group acquired better TIMI flow and TMPG and much lower corrected TIMI frame count after the procedure than compared group,and sumSTR seemed in study group were also higher than that in the control group (P<0.05).More intrestingly,LVEF during hospitalization and at one year follow up were improved in the study group than in the control group, which was statistically significant(P<0.05).Conclusion: Transmicrocatheter intra-coronary injection of tirofiban can be safe and efficient in octogenarians with AMI undergoing emergency PCI because it achieves better myocardium perfusion in microcirculary level and improves patients' LVEF.

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