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目的比较急性心肌梗死患者在行急诊经皮冠状动脉介入治疗(PCI)时,通过抽吸导管冠状动脉病变处给予替罗非班与经指引导管冠状动脉内给予替罗非班的疗效差别。方法选取2013年1月~2016年1月于江苏省丹阳市人民医院行急诊PCI的急性ST段抬高型心肌梗死的患者共81例,其中40例经抽吸导管在罪犯血管堵塞处局部缓慢推注替罗非班,41例经指引导管冠状动脉内缓慢推注替罗非班。主要终点为各种原因的30 d死亡;次要终点包括PCI术后即刻心肌梗死溶栓治疗(TIMI)血流、心肌呈色分级(MBG)、住院期间再次心肌梗死、靶血管重建、不稳定型心绞痛及心力衰竭。结果两组患者年龄、性别、心血管疾病危险因素、血压、心率比较差异无统计学意义。经抽吸导管冠状动脉内局部给药组MBG3级患者明显多于经指引导管给药组(68%vs.36%,P=0.002),非致死性心力衰竭则明显减少(12.5%vs.25.6%,P=0.0027)。两组患者各种原因30 d死亡(2.5%vs.2.4%,P=0.943)、TIMI血流3级(92.5%vs.87.8%,P=0.848)、住院期间再次心肌梗死(0%vs.1.2%,P=0.764)、靶血管重建(2.5%vs.4.9%,P=0.931)及不稳定性心绞痛(15%vs.19.5%,P=0.840)的发生情况差异无统计学意义。结论直接PCI术中经抽吸导管冠状动脉内局部缓慢给药能改善心肌灌注,减少住院期间非致死性心力衰竭发生率,但是对于30 d内不良事件的发生与对照组相比无明显改善。
Objective To compare the efficacy of tirofiban given by catheter-assisted coronary catheterization with tirofiban in patients undergoing acute percutaneous coronary intervention (PCI) in patients with acute myocardial infarction. Methods From January 2013 to January 2016, 81 patients with acute ST-segment elevation myocardial infarction undergoing emergency PCI in Danyang People’s Hospital of Jiangsu Province were enrolled. Among them, 40 cases were locally slow Tirofiban was bolted, and tirofiban was given to 41 patients undergoing guided catheterization of coronary artery. The primary end point was 30-day death for a variety of reasons; secondary end points included immediate TIMI flow, myocardial grading (MBG), myocardial infarction during hospitalization, target revascularization, instability Angina and heart failure. Results There was no significant difference in age, sex, risk factors of cardiovascular disease, blood pressure and heart rate between the two groups. The number of MBG-3 patients in the intra-coronary catheterization group was significantly higher than that in the catheter-guided catheter group (68% vs.36%, P = 0.002), and non-fatal heart failure was significantly reduced (12.5% vs.25.6 %, P = 0.0027). Thirty-day mortality (2.5% vs.2.4%, P = 0.943), TIMI grade 3 (92.5% vs.87.8%, P = 0.848), and myocardial infarction (0% vs. 1.2%, P = 0.764). There was no significant difference in the incidence of target vessel reconstruction (2.5% vs 4.9%, P = 0.931) and unstable angina (15% vs.19.5%, P = 0.840). Conclusions The slow local administration of aspiration catheters in the coronary arteries can improve myocardial perfusion and reduce the incidence of non-fatal heart failure during hospitalization. However, there is no significant improvement in the incidence of adverse events within 30 days compared with the control group.