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目的:评价超选择性冠状动脉内注射硝普钠对急性心肌梗死(AMI)患者急诊经皮冠状动脉介入(PCI)治疗中梗死相关动脉(IRA)无复流现象的作用。方法:选择AMI急诊PCI后再通的IRA存在无复流现象者43例。21例患者经血栓抽吸导管超选择性梗死相关冠状动脉内注射法,22例患者采用常规指引导管内注射方法。药物均采用硝普钠100μg,2 s内“弹丸式”快速注射完毕。10 min后复查冠状动脉造影,评定冠状动脉血流TIMI分级及校正TIMI帧数(cTFC)。结果:两组均可明显改善急诊PCI后的无再流现象,超选择组所有患者梗死相关血管IRA血流恢复TIMIⅢ级,cTFC帧数由用药前的(84±7)帧降至(26±6)帧,与常规组相比较差异有统计学意义(P<0.01)。结论:超选择性IRA内快速注射硝普钠100μg能更有效地改善AMI急诊PCI中无再流现象。
AIM: To evaluate the effect of super selective intra-coronary sodium nitroprusside on no-reflow phenomena in infarct-related artery (IRA) in patients undergoing acute percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods: A total of 43 patients with no-reflow phenomenon were selected after AMI emergency PCI. Twenty-one patients underwent thrombus aspiration catheter-dependent intracoronary injection, and 22 patients underwent conventional catheterization. Drugs are used sodium nitroprusside 100μg, 2 s within the “bolus type” fast injection is completed. Coronary angiography was reviewed after 10 min, and TIMI grading and corrected TIMI frames (cTFC) of coronary blood flow were assessed. Results: No reflow was observed after emergency PCI in both groups. TIMI Ⅲ level was restored in infarct-related IRA blood flow in all patients in the superselective group, and the number of cTFC frames was reduced from (84 ± 7) before administration to (26 ± 6) frames, the difference was statistically significant compared with the conventional group (P <0.01). CONCLUSION: Rapid injection of 100 μg sodium nitroprusside into IRS can improve the no-reflow phenomenon in AMI emergency PCI more effectively.