血栓抽吸导管联合替罗非班在急性ST段抬高性心肌梗死介入治疗中的应用

目的观察急性sT段抬高性心肌梗死（ST—EMI）患者行急诊冠状动脉介入治疗（PCI）过程中及术后，DIVERTM CE血栓抽吸导管与血小板糖蛋白Ⅱb／Ⅲa受体拮抗剂替罗非班（冠状动脉内推注后静脉滴注维持）联合应用的临床疗效及安全性。方法选择2008年4月至2011年3月间符合PCI治疗条件的急性sT段抬高性心肌梗死患者共60例。按入院顺序将患者随机归为两组：32例（A组）患者给予替罗非班；28例患者（B组）给予DIVER TM CE血栓抽吸导管与替罗非班联合应用。比较两组患者手术前后的心肌梗死血管（TIMI）血流变化、出血性并发症和住院期间主要心脏不良事件（MACE）的发生率。结果B组术后即刻TIMI血流改善效果明显优于A组，在住院期间MACE的发生率低于A组（25．0％vs3．6％，P〈0．05），两组均无致命性出血并发症。结论在急性sT段抬高性心肌梗死PCI中应用DIVER TM CE血栓抽吸导管与替罗非班（冠状动脉内推注后静脉滴注维持）能够明显减少冠状动脉内血栓，减少无复流现象，降低住院期间心血管事件发生率，亦无致命性出血并发症，是一种安全有效的治疗方法。

Application of tirofiban and thrombus-aspiration catheter in the percutaneous coronary intervention-treated patients with acute ST-segment elevation myocardial infarction

Objective To assess the effects and safety of glycoprotein Ⅱ b/Ⅲ a receptor inhibitors tirofiban（intracoronary administration and venous maintenance） combined with DIVERTMCE thrombus-aspiration catheter in the percutaneous coronary intervention （PCI）-treated patients with acute ST-segment ele- vation myocardial infarction （ST-EMI）. Methods Sixty patients with ST-EMI who underwent PCI were randomized into two groups. Thirty-two patients in group A were treated with tirofiban, twenty-eight patients in group B were treated with tirofiban and tbrombus-aspiration catheter. Between two groups, the thrombolysis in myocardial infarction （TIMI） risk score, hemorrhagic complications, and incidence of major adverse cardiovascular events （MACE） were compared. Results The TIMI flow was improved in both groups, and it was better in group B than group A （ P 〈 0.05 ）. The incidence of MACE in group B was lower than group A （25.0% vs 3.6% , P 〈 0. 05 ）. No fatal hemorrhagic complications were found in both groups. Conclusions Application of tirofiban and DIVERTMCE thrombus-aspiration catheter is safe and effective in ST-EMI patients, which can greatly improve myocardial reperfusion and reduce incidence of MACE.