冠状动脉靶病变远端经微导管注射硝普钠对冠状动脉介入治疗中无复流的作用

目的评价冠状动脉靶病变远端经微导管注射和直接冠状动脉内注射硝普钠对经皮冠状动脉介入（ percutaneous coronary intervention, PCI） 治疗中“无复流”的作用。方法选择PCI治疗中存在“无复流”现象的患者56例为研究对象，其中21例入选普通组，经指引导管冠状动脉内注射硝普钠200斗g；23例入选改良组，经微导管注射硝普钠至靶病变远端：12例为对照组，经微导管注射O．9％氯化钠溶液至靶病变远端。10min后复查冠状动脉造影。评定冠状动脉血流心肌梗死溶栓试验（thrombolysis in myocardial infarction, TIMI）分级及校正TIMI帧数（corrected tbrombolysis in myocardial infarction framecount, CTFC）。结果3组均可改善PCI治疗后的“无复流”现象。普通组12例靶血管血流恢复TIMI3级，CTFC帧数由用药前的（83．2±8．3）帧降至（38．1±7．5）帧；而改良组21例血流恢复TIMI3级，CTFC帧数从（85．6±6．9）帧降至（27．3±6．8）帧；对照组1例血流恢复TIMI3级，CTFC帧数从（84．3±7.4）帧降至（50．8±8．2）帧。改良组疗效明显优于普通组和对照组，差异有统计学意义（P（0．01）。结论PCI治疗中，冠状动脉靶病变远端经微导管注射和经指引导管冠状动脉内注射硝普钠均能改善“无复流”现象。经微导管注射硝普钠至靶病变远端比经指引导管注射能更有效地改善PCI治疗中“无复流”现象。

Effects of nitroprusside injection from microcatheter to far-end target lesions on no-reflow phenomenon during percutaneous coronary intervention

Objectives To investigate the effects of nitroprusside injection from microcatheter to far-end target lesions on no-reflow phenomenon during percutaneous coronary intervention(PCI).Methods A total of 56 patients with no-reflow phenomenon during PCI were included in this study.Patients were divided into common group(nitroprusside 200 μg injection from guiding catheter to target coronary,n=21),modified group(nitroprusside 200 μg injection from microcatheter to far-end target lesions,n=23) and control group(physiological saline 5 mL injection from microcatheter to far-end target lesions,n=12).Coronary angiography was rechecked 10 minutes after injection.Thrombolysis in myocardial infarction(TIMI) and corrected TIMI framecount(CTFC) of target coronary were assessed.Results No-reflow phenomenon relieved in all groups.There were 12,21,1 patients with target coronary TIMI grade 3 in common group,modified group and control group respectively.CTFCs of target coronary were decreased from(85.6±6.9) frame to(27.3±6.8) frame in modified group,while those in common group reduced from(83.2±8.3) frame to(38.1±7.5) frame,those in control group reduced from(84.3±7.4) frame to(50.8±8.2) frame.TIMI and CTFC differences among the three groups had statistical significance(P<0.01),the effects of modified group was the best.Conclusions Nitroprusside injection from guiding catheter and from microcatheter to far-end target lesions are effective and safe treatments for no-reflow phenomenon in PCI,and injection from microcatheter to far-end target lesions can achieve a better effect than from guiding catheter.