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[摘要] 目的 评价急性心肌梗死患者中行血栓抽吸联合替罗非班及硝普钠治疗对无复流或慢血流的影响。 方法 入选2013年1月～2014年12月急性ST段抬高型心肌梗死患者118例，随机分为试验组和对照组各59例，两组患者均进行血栓抽吸。试验组患者在抽吸治疗后冠状动脉内给予替罗非班及硝普钠，对照组患者抽吸后直接行经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）。比较两组患者PCI术后无复流及慢血流发生率的差异、心功能改善、并发症及主要心血管不良事件。 结果 两组患者的临床基线资料及PCI前的TIMI血流、EF无显著差异。试验组PCI术后无复流发生率明显低于对照组，达到TIMI3级对照组42.37%，试验组48.74%，P=0.026。心功能在1周明显改善，心脏彩超射血分数值在对照组（48.75±10.60）%，试验组（53.12±11.37）%，P=0.035。两组患者均未发生严重并发症。随访6个月两组患者均未发生主要心血管不良事件。 结论 急性心肌梗死患者PCI中血栓抽吸联合替罗非班及硝普钠，有助于降低无复流的发生率，有良好的安全性和可行性。
[关键词] ST抬高型心肌梗死；无复流；血栓抽吸；替罗非班；硝普钠
[中图分类号] R542.2 [文献标识码] B [文章编号] 1673-9701（2016）07-0025-04
[Abstract] Objective To study the effect of thrombosis aspiration combined with injection of tirofiban and nitroprusside on no reflow or slow flow of patients with acute myocardial infarction. Methods A total of 118 ST-segment elevation myocardial infarction （STEMI） patients with emergency percutaneous coronary injection （PCI） during Jan 2013 to Dec 2014 were randomly divided into control group （thrombus aspiration only）and observation group（thrombus aspiration and intracoronary tirofiban combined with sodium nitroprusside injection） with 59 patients in each group. Baseline clinical data， TIMI blood flow and ejection fraction（EF） were compared in two groups. EF and adverse events were also compared in 7 days after PCI. The major adverse cardiac event（MACE） was compared in 1 and 6 months after PCI. Results The baseline clinical characteristics data， TIMI blood flow and EF were similar between the two groups before PCI（P>0.05）. TIMI3 blood flow was improved in observation group than in control group（48.74% vs 42.37%，P=0.026）. EF at 7 days after PCI in observation group were superior to those in control group with the significant difference[（48.75±10.60）% vs （53.12±11.37）%，P=0.035]. The complication rate of bleeding was similar between two groups. The MACE was similar between two groups in 1 and 6 months follow up after PCI. Conclusion Intracoronary administration of tirofiban combined with nitroprusside through thrombus aspiration catheter during PCI in STEMI patients with heavy thrombosis burden can improve reperfusion in the infarction area and clinical results and it is safe.
[Key words] ST-segment elevated myocardial infarction； No reflow； Thrombosis aspiration； Tirofiban； Sodium nitroprusside
急诊PCI已成为急性ST段抬高心肌梗死的主要治疗手段。但是，急性心肌梗死患者的冠状动脉内的血栓负荷重，在急诊行经皮冠状动脉介入治疗（PCI）时无复流或慢血流的发生率相对较高，影响患者的临床预后。本研究旨在观察经桡动脉途径接受急诊PCI时行血栓抽吸联合替罗非班及硝普钠对急性心肌梗死患者无复流现象的临床效果，现报道如下。 [11] Liu CP，Lin MS，Chiu YW，et al. Additive benefit of glycoprotein IIb/IIIa inhibition and adjunctive thrombus aspiration during primary coronary intervention：Results of the initial thrombosuction and tirofiban infusion（ITTI） trial[J]. Int J Cardiol，2012，156（2）：174-179.
[12] Zhou SS，Tian F，Chen YD，et al. Combination therapy reduces the incidence of no-reflow after primary per-cutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction[J]. J Geriatr Cardiol，2015，12（2）：135-142.
[13] Jolly SS，Cairns J，Yusuf S，et al. Design and rationale of the TOTAL trial：A randomized trial of routine aspiration Thrombectomy with percutaneous coronary intervention （PCI） versus PCI ALone in patients with ST-elevation myocardial infarction undergoing primary PCI[J]. Am Heart J，2014，167（3）：315-321.
[14] Mahmood MM，Watt J，Ahmed JM. Thrombus aspiration during primary percutaneous coronary intervention for acute myocardial infarction：A review of clinical evidence and guidelines[J]. World J Cardiol，2015，7（12）：889-894.
（收稿日期：2015-12-28）
[关键词] ST抬高型心肌梗死；无复流；血栓抽吸；替罗非班；硝普钠
[中图分类号] R542.2 [文献标识码] B [文章编号] 1673-9701（2016）07-0025-04
[Abstract] Objective To study the effect of thrombosis aspiration combined with injection of tirofiban and nitroprusside on no reflow or slow flow of patients with acute myocardial infarction. Methods A total of 118 ST-segment elevation myocardial infarction （STEMI） patients with emergency percutaneous coronary injection （PCI） during Jan 2013 to Dec 2014 were randomly divided into control group （thrombus aspiration only）and observation group（thrombus aspiration and intracoronary tirofiban combined with sodium nitroprusside injection） with 59 patients in each group. Baseline clinical data， TIMI blood flow and ejection fraction（EF） were compared in two groups. EF and adverse events were also compared in 7 days after PCI. The major adverse cardiac event（MACE） was compared in 1 and 6 months after PCI. Results The baseline clinical characteristics data， TIMI blood flow and EF were similar between the two groups before PCI（P>0.05）. TIMI3 blood flow was improved in observation group than in control group（48.74% vs 42.37%，P=0.026）. EF at 7 days after PCI in observation group were superior to those in control group with the significant difference[（48.75±10.60）% vs （53.12±11.37）%，P=0.035]. The complication rate of bleeding was similar between two groups. The MACE was similar between two groups in 1 and 6 months follow up after PCI. Conclusion Intracoronary administration of tirofiban combined with nitroprusside through thrombus aspiration catheter during PCI in STEMI patients with heavy thrombosis burden can improve reperfusion in the infarction area and clinical results and it is safe.
[Key words] ST-segment elevated myocardial infarction； No reflow； Thrombosis aspiration； Tirofiban； Sodium nitroprusside
急诊PCI已成为急性ST段抬高心肌梗死的主要治疗手段。但是，急性心肌梗死患者的冠状动脉内的血栓负荷重，在急诊行经皮冠状动脉介入治疗（PCI）时无复流或慢血流的发生率相对较高，影响患者的临床预后。本研究旨在观察经桡动脉途径接受急诊PCI时行血栓抽吸联合替罗非班及硝普钠对急性心肌梗死患者无复流现象的临床效果，现报道如下。 [11] Liu CP，Lin MS，Chiu YW，et al. Additive benefit of glycoprotein IIb/IIIa inhibition and adjunctive thrombus aspiration during primary coronary intervention：Results of the initial thrombosuction and tirofiban infusion（ITTI） trial[J]. Int J Cardiol，2012，156（2）：174-179.
[12] Zhou SS，Tian F，Chen YD，et al. Combination therapy reduces the incidence of no-reflow after primary per-cutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction[J]. J Geriatr Cardiol，2015，12（2）：135-142.
[13] Jolly SS，Cairns J，Yusuf S，et al. Design and rationale of the TOTAL trial：A randomized trial of routine aspiration Thrombectomy with percutaneous coronary intervention （PCI） versus PCI ALone in patients with ST-elevation myocardial infarction undergoing primary PCI[J]. Am Heart J，2014，167（3）：315-321.
[14] Mahmood MM，Watt J，Ahmed JM. Thrombus aspiration during primary percutaneous coronary intervention for acute myocardial infarction：A review of clinical evidence and guidelines[J]. World J Cardiol，2015，7（12）：889-894.
（收稿日期：2015-12-28）