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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sum STR、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sum STR≥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 investigate the efficacy and safety of microcirculation coronary intervention in patients undergoing percutaneous coronary intervention (PCI) with ultra-advanced ST-elevation myocardial infarction (MI). Methods: A retrospective analysis of 78 cases of ultra-elderly acute ST-segment elevation myocardial infarction confirmed by emergency coronary angiography (IRA), myocardial infarction thrombolysis (TIMI) thrombosis points in patients with more than 3 points, divided into Twenty-four patients in the control group (control group, n = 42) and intracoronary injection of tirofumab-treated patients (36 patients in the study group) TIMI flow grade, postoperative TIMI flow meter frame count, TIMI myocardial perfusion (TMPG) grading, 90 min postoperative electrocardiogram sum STR, left ventricular ejection fraction (LVEF) during hospitalization and 1 year follow-up, bleeding Incidence and major cardiac adverse events (MACE) the incidence of any difference. Results: The incidence of postoperative TIMI blood flow grade 3, TMPG grade 3 and 90 min electrocardiogram sum STR≥70% were significantly higher in the study group than in the control group, and the postoperative corrected TIMI flowmetry frame study group was also significantly lower than (P <0.05). The LVEF of the study group was higher than that of the control group during the hospitalization and 1 year after follow-up, the difference was statistically significant (P <0.05), but the bleeding and MACE The incidence was no significant difference (P> 0.05). CONCLUSION: Tilofiban intracoronary injection of tirofiban in the treatment of elderly patients with acute ST-segment elevation myocardial infarction can effectively improve the TIMI grade, myocardial perfusion, left ventricular function during hospitalization and 1 year after operation , And the treatment is safe.