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急性心肌梗死介入治疗中血栓抽吸及不同途径给予替罗非班的临床研究

王立文1,黄体钢2,浦奎1,翟耀东1,李冬1   

  1. 1. 天津解放军254医院
    2. 天津医科大学第二医院
  • 收稿日期:2011-11-07 修回日期:2012-05-22 出版日期:2012-11-15 发布日期:2012-11-15
  • 通讯作者: 王立文

The clinical study of thrombus aspiration and different ways of giving tirofiban in Interventional treatment of acute myocardial infarction

  • Received:2011-11-07 Revised:2012-05-22 Published:2012-11-15 Online:2012-11-15

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摘要： 摘要 目的 探讨在ST段抬高性心肌梗死（STEMI）直接PCI术中，血栓抽吸及不同途径给予替罗非班的急性期及远期效果。方法 试验分为三组：1)单纯血栓抽吸组。2）血栓抽吸+周围静脉替罗非班组，抽吸血栓后首先予以替罗非班10μg.kg静推，继而以维持量0.15μg.kg－1.min－1维持24小时。3）血栓抽吸+梗死相关动脉内替罗非班组，抽吸血栓后首先经抽吸导管注射替罗非班500μg，继而以维持量0.15ug.kg－1.min－1维持24小时.观察血管再通情况；术前及术后90min心电图ST段回落情况；CK-MB酶峰；术后24小时及术后6月左心室射血分数；随访患者的出血及心血管不良事件。结果：三组患者基本情况没有统计学差异；血栓抽吸后前向血流均达到TIMI3级；术后90minST段回落:血栓抽吸+周围静脉替罗非班组及血栓抽吸+梗死相关动脉内替罗非班组ST段回落较单纯血栓抽吸组有统计学差异，两组比较差异不明显；CK-MB酶峰：血栓抽吸+周围静脉替罗非班组及血栓抽吸+梗死相关动脉内替罗非班组CK-MB酶峰较单纯血栓抽吸组显著降低（p<0.05），两组比较差异显著（p<0.05 ）；术后24小时血栓抽吸+梗死相关动脉内替罗非班组左心室射血分数高于血栓抽吸+周围静脉替罗非班组及单纯血栓抽吸组，血栓抽吸+周围静脉替罗非班组及单纯血栓抽吸组相比较也有统计学意义（p<0.05 ）；术后6月三组左心室射血分数比较无统计学差异。三组患者随访期间均未出现出血及心血管不良事件。结论：急性ST段抬高性心肌梗死直接PCI中，血栓抽吸联合替罗非班在改善心肌灌注、保护急性期左心功能方面优于单纯血栓抽吸，且梗死相关动脉内给药优于周围静脉给药。血栓抽吸及不同途径给予替罗非班对远期左心功能影响无差别。

关键词: 心肌梗死, 血栓抽吸, 替罗非班, 心肌灌注, 左心功能

Abstract: Abstract Objective To investigate the ST-segment elevation myocardial infarction (STEMI) patients in primary PCI, thrombus aspiration and different ways of giving tirofiban acute and long-term effects. Methods Patients were divided into three groups:1) simple thrombus aspiration group. 2) thrombus aspiration + tirofiban given by peripheral venous group, after thrombus aspiration to be the first 10μg.kg tirofiban bolus, followed by maintenance dose 0.15μg.kg-1.min-1 for 24 hours. 3) thrombus aspiration + tirofiban given by intra-infarction related artery group,after thrombus aspiration to inject tirofiban 500μg through the suction catheter , followed by maintenance dose 0.15ug.kg-1.min-1 for 24 hours. To observe the case of recanalization,preoperative and 90minutes after angioplasty ST-segment of ECG,peak of CK-MB, left ventricular ejection fraction 24 hours and 6 months after angioplasty. Follow-up of patients with bleeding and cardiovascular adverse events. Results The basic situation of three groups of patients was not statistically significant, forward flow reached TIMI 3 level after thrombus aspiration.The case of ST-segment after 90 minutes: group 2) and group 3) were significantly different from group 1). And the difference between group 2) and group 3)was not obvious. Peak of CK-MB:group 2) and group 3) were significantly different from group 1). And the difference between group 2) and group 3) was significantly different too.24 hours after angioplasty the left ventricular ejection fraction of group 3) was higher than group 2) and group 1), there was statistically significant between group 2) and group 1) (p <0.05 ). The left ventricular ejection fraction of three groups showed no significant difference after 6 months . Three groups of patients during follow-up were not bleeding and cardiovascular adverse events. Conclusion Primary PCI in acute ST-segment elevation myocardial infarction , thrombus aspiration combined tirofiban is better than a simple thrombus aspirationin in protecting left ventricular function and improving myocardial perfusion in acute phase , Within the intra-infarction related artery is better than the surrounding intravenous administration. Thrombus aspiration and different ways of giving tirofiban had no difference in long-term impact of left ventricular function.

Key words: Myocardial infarction, Thrombus aspiration, Tirofiban, Myocardium perfusion, Left ventricular function