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目的观察PCI术中血栓抽吸联合替罗非班在急性ST段抬高型心肌梗死(STEMI)患者中的疗效。方法 2010年8月至2012年8月住院治疗的急性STEMI患者118例,随机分为观察组(PCI+血栓抽吸联合替罗非班)62例和对照组(直接PCI)56例。观察PCI术后即刻TIMI血流分级、无复流发生率、球囊使用率、支架置入率、ST段回落率、肌钙蛋白T(TnT)峰值和肌酸激酶同工酶(CK-MB)峰值、左心室射血分数(LVEF)、6个月内主要心血管不良事件(MACE)的发生率。结果与对照组比较,观察组术后TIMI 3级血流发生率明显增高(P<0.01),无复流发生率明显减少(P<0.01),球囊使用率明显降低(P<0.01),两组支架植入率相当(P>0.05)。与对照组比较,观察组的TnT及CK-MB峰值显著降低(P均<0.01),心电图的ST段回落率、LVEF值明显增加(P<0.01,P<0.05),6个月内的心衰发生率、再次AMI发生率显著降低(P<0.01,P<0.05)。结论 PCI术中血栓抽吸联合替罗非班能明显降低急性STEMI患者冠脉内血栓负荷,改善冠脉血流,减小梗死面积,改善患者的预后。
Objective To observe the efficacy of thrombectomy combined with tirofiban in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 118 acute STEMI patients hospitalized from August 2010 to August 2012 were randomly divided into observation group (PCI + thrombus and tirofiban) in 62 cases and control group (direct PCI) in 56 cases. The TIMI grade, no-reflow incidence, balloon coverage, stent placement, ST-segment resolution, peak troponin T (TnT) and creatine kinase MB ) Peak, left ventricular ejection fraction (LVEF), incidence of major cardiovascular adverse events (MACE) within 6 months. Results Compared with the control group, the incidence of TIMI grade 3 blood flow in the observation group was significantly increased (P <0.01), the incidence of no-reflow significantly decreased (P <0.01), and the balloon utilization rate was significantly decreased (P <0.01) The stent implantation rate was similar in both groups (P> 0.05). Compared with the control group, the peak values of TnT and CK-MB in the observation group were significantly lower (all P <0.01), ST-segment echo rate and LVEF in the ECG were significantly increased (P <0.01, P <0.05) The incidence of anemia and AMI were significantly lower (P <0.01, P <0.05). Conclusions Thrombus aspiration combined with tirofiban in PCI can significantly reduce coronary thrombus load, improve coronary blood flow, reduce infarct size and improve prognosis in patients with acute STEMI.