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目的 评价冠状动脉内应用硫氮酮 (diltiazem)对急性心肌梗死 (AMI)直接经皮冠状动脉腔内成形和支架术 (PTCA/Stent)后梗死相关动脉缓再血流 (slow reflow)现象的疗效及其安全性。方法 2 0例AMI直接PTCA/Stent后再通的梗死相关动脉 (infarct relatedartery ,IRA)存在slow reflow患者 ,男 13例 ,女 7例 ,年龄 (5 8 5± 9 5 )岁。其中闭塞血管右冠状动脉 10例 ,前降支 6例 ,回旋支 4例。从症状开始至PTCA/Stent开通IRA时间 (9 2± 2 1)h ,术后平均TIMI血流 (1 9± 0 4)级 ,先以硝酸甘油(nitroglycerin) 15 0 μg冠脉内注入 (确认slow reflow现象 )作为对照 ,10min后继以Diltiazem 5 0 0 μg(5 0 μg·ml-1·s-1)冠状动脉内注入 ,于给药后第 1、3、10min行冠状动脉造影 (CAG)。应用Gibson的TIMI血流计帧法和QCA测量系统分别行Nitroglycerin和Diltiazem冠状动脉内给药后不同时间点IRA再通后血流速率帧数和管腔直径的定量分析比较。结果 (1)术后基础对照与Nitroglycerin给药 3min时CAG血流帧数比较无明显变化 (89 8± 18 1)vs (88 9± 14 2 )帧 ,P >0 0 5 ;Diltiazem给药后第 1、3和 10min时CAG血流帧数分别较给药前减少 2 7 6 % ,32 6 %和 2 5 2 % (P均 <0 0 1) ,平均TIMI血流增加从(1 9± 0 5
Objective To evaluate the effect of intra-coronary diltiazem on infarct-related slow reflow after acute percutaneous transluminal coronary angioplasty (PTCA / Stent) and acute myocardial infarction (AMI) Efficacy and safety. Methods Twenty patients with slow reflow were included in the study. Twenty-three patients were male and 7 were female, with a mean age of (585 ± 95) years. Including the right coronary artery in 10 cases, anterior descending artery in 6 cases, 4 cases of supination. The duration of IRA (9 2 ± 2 1) h after PTCA / Stent was switched on and the mean TIMI flow (1 9 ± 0 4) after PTCA / Stent injection were initially given by intracoronary injection of nitroglycerin slow reflow phenomenon) as a control, 10 min followed by Diltiazem 500 μg (50 μg · ml-1 · s-1) intracoronary injection, at 1, 3, 10 min after coronary angiography (CAG) . Using Gibson TIMI flowmetry frame method and QCA measurement system, we compared the blood flow velocity frames and lumen diameter at different time points after coronary artery administration of Nitroglycerin and Diltiazem respectively. Results (1) There was no significant difference in the number of CAG blood flow between the baseline control group and the Nitroglycerin administration group (89 8 ± 18 1 vs 88 9 ± 14 2), P> 0.05 after administration of Diltiazem At 1, 3 and 10 min, the number of CAG blood flow decreased by 27.6%, 32.6% and 25.2% (P <0.01), respectively, and the average TIMI blood flow increased from (19 ± 0 5