联合抽吸导管内注射替罗非班治疗急性ST段抬高型心肌梗死临床研究

目的探讨急性sT段抬高心肌梗死（STEMI）急诊经皮冠状动脉介入治疗（PCI）中联合应用血栓抽吸导管和替罗非班经抽吸导管内注射对心肌组织灌注及临床预后的影响。方法106例急诊PCI治疗的STEMI患者根据治疗情况分为血栓抽吸＋替罗非班组（52例）和单独血栓抽吸组（54例），比较两组患者手术后即刻梗死相关动脉的心肌梗死溶栓（TIMI）血流、TIMI心肌灌注分级（TMP）。随访30d，比较两组左心室射血分数（LVEF）、住院期间主要心脏不良事件和出血并发症发生率。结果两组基线资料比较差异无统计学意义。术前、术后两组TIMI血流，术前两组TMP差异无统计学意义（P〉0．05）。术后血栓抽吸＋替罗非班组TMP3级率较单独抽吸组明显高（76．2比68．5，P〈0．05）。两组30d随访主要心脏不良事件、LVEF、出血并发症比较差异无统计学意义（P〉0．05）。结论在STEMI急诊PCI中联合使用血栓抽吸导管和抽吸导管内注射替罗非班安全可行，可有效改善心肌组织灌注，且不增加主要心脏不良事件的发生率。

Effects of thrombus aspiration devices combine tirofiban in acute ST segment elevation myocardial infarction patients with direct percutaneous coronary intervention

Objective To study the myocardial infusion and clinical outcome effects of using thrombus aspiration devices or combining tirofiban through thrombus aspiration in acute ST segment elevation myocardial infarction patients with direct percutaneous coronary intervention. Methods 106 STEMI patients with direct PCI were divided into thrombus aspiration devices combine tirofiban group and single thrombus aspiration group. TIMI flow and TIMI myocardial perfusion （TMP） were compared. After followed up 30 days, left ventricular eject fraction, major adverse cardiac effects and bleed were compared. Results Two groups had no differences in general data. TIMI flow had no difference before or after PCI （P〉0.05）, TMP 3 grade were higher in thrombus aspiration devices combine tirofiban group than single thrombus aspiration group （76.2 vs 68.5, P〈0.05）. After 30 days follow up, the left ventricular eject fraction, major adverse cardial effects and bleed were no differences between two group （P〉0.05）. Conclusion For acute STEMI, thrombus aspiration devices combine tirofiban in direct PCI are safety, and improve myocardial infusion without adding adverse outcome.