[1]刘翔宇,陈旭红,王 娟,等.替罗非班联合血栓抽吸对急性 ST 段抬高型心肌梗死患者经皮冠状动脉介入治疗效果的影响[J].新乡医学院学报,2020,37(9):877-880.[doi:10.7683/xxyxyxb.2020.09.017]
 LIU Xiangyu,CHEN Xuhong,WANG Juan,et al.Effect of tirofiban combined with thrombus aspiration on acute ST-elevation myocardial infarction patients undergoing percutaneous coronary intervention[J].Journal of Xinxiang Medical University,2020,37(9):877-880.[doi:10.7683/xxyxyxb.2020.09.017]
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替罗非班联合血栓抽吸对急性 ST 段抬高型心肌梗死患者经皮冠状动脉介入治疗效果的影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年9
页码:
877-880
栏目:
临床研究
出版日期:
2020-09-05

文章信息/Info

Title:
Effect of tirofiban combined with thrombus aspiration on acute ST-elevation myocardial infarction patients undergoing percutaneous coronary intervention
作者:
刘翔宇陈旭红王 娟杨淑玲尚 伟
(焦作市人民医院心内科二区,河南 焦作 454000)
Author(s):
LIU XiangyuCHEN XuhongWANG JuanYANG ShulingSHANG Wei
(Department of Cardiology,the People′s Hospital of Jiaozuo,Jiaozuo 454000,Henan Province,China)
关键词:
心肌梗死替罗非班血栓抽吸经皮冠状动脉介入治疗支架植入术心肌缺血再灌注
Keywords:
myocardial infarctiontirofibanthrombus aspirationpercutaneous coronary interventionstent implantationmyocardial ischemia reperfusion
分类号:
R542.22
DOI:
10.7683/xxyxyxb.2020.09.017
文献标志码:
A
摘要:
目的 探讨替罗非班联合血栓抽吸对急性 ST 段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)效果的影响。方法 选择2016年1月至2017年12月于焦作市人民医院行PCI的164例急性STEMI患者为研究对象,根据治疗方法分为观察组和对照组,每组82例。对照组患者给予经皮冠状动脉球囊扩张后支架植入术或直接支架植入术;观察组患者由引导管注入替罗非班10 μg·kg-1,然后进行血栓抽吸,再植入支架。对2组患者PCI术后心肌梗死溶栓(TIMI)血流分级、PCI术后即刻造影结果、术后90 min心电图ST段回落率、血清肌酸激酶同工酶(CK-MB)峰值、术后1周左心室射血分数(LVEF)及术后出血率进行比较;所有患者术后随访1 a,观察主要心血管不良事件(MACE)发生情况。结果 观察组患者无复流发生率、CK-MB峰值、校正的TIMI帧数显著低于对照组(P<0.05);观察组患者LVEF、ST段回落>50%所占比例显著高于对照组(P<0.05)。观察组患者术后TIMI分级显著优于对照组(P<0.05)。观察组和对照组患者术后轻度出血发生率分别为20.7%(17/82)、15.9%(13/82),2组患者轻度出血发生率比较差异无统计学意义(χ2=0.649,P>0.05)。术后1 a内,观察组和对照组患者MACE发生率分别为9.8%(8/82)、15.9%(13/82),2组患者术后1 a内MACE发生率比较差异无统计学意义(χ2=1.357,P>0.05)。结论 替罗非班联合血栓抽吸可以显著改善STEMI患者PCI后心肌再灌注水平。
Abstract:
Objective To investigate the effect of tirofiban combined with thrombus aspiration on acute ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI).Methods A total of 164 patients with acute STEMI who underwent PCI in the People′s Hospital of Jiaozuo from January 2016 to December 2017 were selected as the research subjects,and they were divided into observation group and control group according to therapeutic method,with 82 cases in each group.The patients in the control group were treated with stent implantation after percutaneous coronary balloon angioplasty or direct stent implantation.The patients in the observation group were injected with tirofiban 10 μg·kg-1 through the guide tube,followed by thrombus aspiration and stent implantation.The thrombolysis in myocardial infarction (TIMI) classification after PCI,the results of angiography immediately after PCI,the ST-segment resolution rate at 90 minutes after PCI,the peak value of serum creatine kinase-MB (CK-MB),left ventricular ejection fraction (LVEF) at one week after operation and postoperative bleeding rate were compared between the two groups.All patients were followed up for one year to observe the major adverse cardiovascular events (MACE).Results The incidence of no reflow,the peak value of serum CK-MB and corrected TIMI frame count in the observation group were significantly lower than those in the control group (P<0.05).The LVEF and the proportion of patients with ST-segment resolution > 50% in the observation group was significantly higher than that in the control group (P<0.05).The TIMI classification of patients in the observation group was significantly better than that in the control group (P<0.05).The incidence of postoperative mild bleeding in the observation group and the control group was 20.7% (17/82) and 15.9% (13/82),respectively.There was no significant difference in the incidence of mild bleeding between the two groups (χ2=0.649,P>0.05).Within one year after operation,the incidence of MACE in the observation group and the control group was 9.8% (8/82) and 15.9% (13/82),respectively.There was no significant difference in the incidence of MACE between the two groups (χ2=1.357,P>0.05).Conclusion Tirofiban combined with thrombus aspiration can significantly improve myocardial reperfusion in STEMI patients after PCI.

参考文献/References:

[1] 李忠强.血栓抽吸导管联合替罗非班治疗急性ST段抬高型心肌梗死80例[J].中国医药指南,2018,16(30):48-49.
[2] 陈胜勇,陈瑶,曾迪,等.急诊PCI术中冠脉内血栓抽吸结合注射替罗非班的临床观察[J].中国急救医学,2015,35(12):276-277.
[3] 张在勇,张稳柱,宋明才,等.血栓抽吸结合血栓部位注射替罗非班在急诊PCI中的应用[J].临床心血管病杂志,2014,30(5):384-387.
[4] 刘伟.血栓抽吸导管注射替罗非班急诊介入治疗急性心肌梗死[J].实用中西医结合临床,2019,19(2):9-10,64.
[5] 郭二伟.血栓抽吸联合替罗非班治疗急性心肌梗死急诊介入应用观察[J].实用中西医结合临床,2018,18(9):69-70.
[6] 孙志华,孙淑艳.血栓抽吸术、替罗非班联用治疗STEMI高血栓负荷患者效果分析[J].包头医学院学报,2018,34(11):1-2.
[7] TASAL A,BACAKSIZ A,VATANKULU M A,et al.Is postdilatation with a noncompliant balloon necessary after coronary stent deployment during primary angioplasty[J].J Interv Cardiol,2013,26(4):325-333。
[8] 詹小娜,包恩泽,李贵华,等.替格瑞洛联合小剂量替罗非班对行急诊经皮冠状动脉介入术老年急性ST段抬高型心肌梗死患者梗死相关动脉血流及主要不良心血管事件的影响[J].新乡医学院学报,2018,35(7):584-587.
[9] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[10] 易日霞,李朋,李睿,等.急诊PCI患者术中应用替罗非班联合血栓抽吸的临床疗效分析[J].中国现代药物应用,2018,12(7):122-123.
[11] 华永平,邓婷婷,席岗,等.心血管介入、血栓抽吸联合替罗非班治疗急性心肌梗死的临床观察[J].中国当代医药,2014,21(19):39-41.
[12] 张军,蒋健刚.冠状动脉内注射替罗非班对急性冠脉综合征介入治疗中无复流的影响[J].安徽医学,2012,33(2):155-157.
[13] LUZ A,RODRIGUES P,SOUSA M J,et al.Thrombus aspiration for reperfusion in myocardial infaretion:predictors and clinical impact of ineffectiveness[J].Rev Port Cardiol,2014,33(12):753-760.
[14] 毛红岩.急性心肌梗死介入治疗中血栓抽吸联合替罗非班的疗效[J].医学理论与实践,2018,31(8):1144-1146.
[15] TATLISU M A,KAYA A,KESKIN M,et al.The association of the coronary thrombus burden with all cause mortality and major cardiac events in ST-segment elevation myocardial infarction patients treated with tirofiban[J].Coron Artery Dis,2016,27(7):543-550.
[16] GALASSO G,SCHIEKOFER S,D′ANNA C,et al.No-reflow phenomenon pathophyslology diagnosis prevention,and treatment:a review of the current literature and future perspectives[J].Angiology,2014,65(3):180-189.
[17] 程仁力,尤家聪,孙彤,等.血栓抽吸联合替罗非班治疗急性心肌梗死的效果[J].中国老年学杂志,2018,38(3):527-529.

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更新日期/Last Update: 2020-09-05