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目的:观察急性心肌梗死患者急诊冠状动脉介入治疗(PCI)中冠状动脉内给予硝普钠或冠状动脉内给予硝酸甘油的临床疗效。方法:将急性ST段抬高型心肌梗死的患者152例随机分为硝普钠组(78例)和硝酸甘油组(74例),常规治疗的基础上,冠状动脉内分别注射硝普钠或硝酸甘油,PCI后行冠状动脉造影检查,观察其TIMI血流分级及ST段50%回落率,并观察患者住院期间及术后6个月内的心血管事件发生率,作为评价指标。结果:2组患者临床基本指标比较无统计学差异(P>0.05);慢血流与无复流的发生率硝酸甘油组高于硝普钠组(P<0.05);PCI后6个月随访示硝普钠组与硝酸甘油组患者左室射血分数、左室舒张末直径以及心脏不良事件发生率比较,均差异有统计学意义(P<0.05)。结论:PCI中冠状动脉内给予硝普钠较硝酸甘油可明显改善冠状动脉慢血流或无复流,对于急性心肌梗死患者可改善术后即刻血流,减少远期临床事件。
Objective: To observe the clinical efficacy of intracoronary nitroglycerin and intracoronary nitroglycerin in patients with acute myocardial infarction undergoing emergency coronary intervention (PCI). Methods: A total of 152 patients with acute ST-elevation myocardial infarction were randomly divided into sodium nitroprusside group (n = 78) and nitroglycerin group (n = 74). On the basis of conventional treatment, intracoronary injection of sodium nitroprusside or Nitroglycerin and PCI were performed coronary angiography. TIMI flow classification and 50% fall-off rate of ST segment were observed. The incidence of cardiovascular events during hospitalization and within 6 months after operation was observed as evaluation index. Results: There was no significant difference between the two groups (P> 0.05). The incidences of slow and no-reflow were higher in nitroglycerin group than those in sodium nitroprusside group (P <0.05) There was significant difference between the sodium nitroprusside group and the nitroglycerin group in left ventricular ejection fraction, left ventricular end-diastolic diameter and incidence of cardiac adverse events (P <0.05). CONCLUSIONS: Intracoronary administration of sodium nitroprusside versus nitroglycerin in PCI significantly improves the slow or no-reflow of coronary arteries and improves immediate postoperative blood flow in patients with acute myocardial infarction, reducing long-term clinical events.