血栓抽吸联合冠脉内注射替罗非班治疗急性ST段抬高型心肌梗死的疗效观察

目的：评价在急性ST段抬高型心肌梗死（STEMI）患者直接经皮冠状动脉介入治疗（PCI）中联合应用血栓抽吸和经指引导管梗死相关动脉内注射替罗非班的有效性和安全性。方法选取100例STEMI患者，观察组为血栓抽吸＋替罗非班组（50例），血栓抽吸后3 min内经指引导管梗死相关动脉内注射替罗非班500μg并植入支架，后静脉滴入替罗非班0.1μg/（kg·min）]12 h；对照组为单纯血栓抽吸组（50例）。观察两组术前TIMI血流分级、MBG分级，术后TIMI血流分级及MBG分级增加值、手术时间以及ST段完全回落率、CK-MB和TnT峰值、左心室射血分数、临床终点事件和出血事件。结果治疗后观察组TIMI血流分级及MBG分级增加值较对照组明显改善（P＜0.05）；术后心电图ST段完全回落率、PCI治疗后16 h及3个月超声心动图LVEF值显著高于对照组（P＜0.05）；CK-MB和TNT峰值明显低于对照组（P＜0.05）。观察组在临床终点事件总发生率方面明显低于对照组（P＜0.05），而两组在出血并发症方面差异无统计学意义。结论PCI联合应用血栓抽吸和经指引导管在梗死相关动脉内应用替罗非班可以改善心肌灌注，安全有效。

Clinical efficacy of intracoronary thrombus aspiration Joint tirofiban treatment of acute ST-segment elevation myocardial infarction

Objective To evaluate the ST segment elevation myocardial infarction（STEMI）patients undergoing percutaneous coronary intervention directly therapy（PCI）in combination thrombus aspiration and the infarct-related artery via a suction catheter for injection tirofiban efficacy and safety. Methods 100 cases STEMI hospital patients were chosen.The observation group was gave thrombus aspiration＋tirofiban group（50 cases）, thrombus aspiration within 3 min after the infarct-related artery via a suction catheter injection of 500μg tirofiban and stenting , after intravenous non-drip classes（0.1μg/kg·min）12 h;the control group was simply thrombus aspiration group（50 cases）, observed before surgery TIMI flow grade , MBG increased grading, grading and MBG after TIMI classification value, the operation time and the rate of complete ST-segment, CK-MB and TnT peak, left ventricular ejection fraction, end events and bleeding events. Results After treatment, the observation group TIMI flow grade and MBG added value improved significantly（P 〈 0.05）;postoperative ST segment completely fall rate, 16h and 3month after PCI treatment echocardiography LVEF was significantly higher（P〈0.05）;CK-MB and TnT peak was significantly lower than the control group（P〈0.05）;in clinical endpoint event total incidence of observation group was obviously lower than the control group（P〈0.05）, and two groups had no statistically significant difference in bleeding complications. Conclusion Joint direct PCI thrombus aspiration and suction catheter through the infarct-related artery in select applications tirofiban can safely and effectively improve myocardial perfusion.