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目的观察急性心肌梗死(AMI)择期经皮冠状动脉介入治疗(PCI)中应用血栓抽吸联合冠脉内注射替罗非班的临床应用价值。方法选择80例行择期PCI的AMI恢复期患者,随机分为观察组40例,术中使用血栓抽吸导管联合冠脉内注射替罗非班,对照组40例,行常规PCI的患者。比较两组间慢血流或无复流发生率、术后冠脉血流灌注水平(TIMI分级)、心肌组织灌注分级(TMP)、术后1月经心脏彩色超声测定的心功能、1年内的主要心脏不良事件和出血等并发症发生率。结果两组患者的一般资料差异无统计学意义(P﹥0.05)。观察组术后TIMI3级血流发生率、TMP明显高于对照组;观察组术后慢血流、无复流发生率明显低于对照组;观察组术后1月射血分数明显高于对照组,E峰/A峰﹤1的百分比明显低于对照组;左心室舒张末期内径明显小于对照组;差异均有统计学意义(P﹤0.05)。术后1年内两组患者均未出现死亡、靶血管血运重建、再梗死等主要心脏不良事件。两组在出血等并发症发生率方面比较差异无统计学意义(P﹥0.05)。结论在AMI择期PCI中应用血栓抽吸联合冠脉内注射替罗非班是安全有效的,值得临床推广应用。
Objective To observe the clinical value of thrombus aspiration combined with intracoronary injection of tirofiban in patients undergoing elective coronary intervention (AMI) with acute myocardial infarction (AMI). Methods Eighty patients undergoing elective PCI with AMI were enrolled in this study. They were randomly divided into observation group (n = 40), thrombus aspiration catheter and intracoronary injection of tirofiban (n = 40), and control group (n = 40). The incidences of slow or no-reflow, coronary flow perfusion (TIMI grade), myocardial perfusion grade (TMP), cardiac function measured by colorimetric ultrasonography at 1 month after operation, The incidence of major cardiac adverse events and bleeding and other complications. Results There was no significant difference in general data between the two groups (P> 0.05). The incidence of postoperative TIMI grade 3 blood flow and TMP in the observation group were significantly higher than those in the control group. The incidence of postoperative slow and no-reflow in the observation group was significantly lower than that in the control group. The ejection fraction in the observation group was significantly higher than that in the control Group, the percentage of E peak / A peak <1 was significantly lower than that of the control group; the end-diastolic diameter of left ventricular was significantly smaller than that of the control group (P <0.05). Within 1 year after operation, no major adverse cardiac events such as death, revascularization of target vessel and reinfarction occurred in either group. There was no significant difference in the incidence of complications such as bleeding between the two groups (P> 0.05). Conclusion Thrombus aspiration combined with intracoronary injection of tirofiban in AMI elective PCI is safe and effective, which is worthy of clinical application.