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1.
The aim of our study was to examine the role of a new, simple protocol of intracoronary adenosine administration performed during primary angioplasty on the immediate angiographic results and clinical course. A prospective, single-center, randomized, placebo-controlled trial of 70 consecutive patients (64 ± 14 years, 54 men) with acute myocardial infarction with ST-segment elevation undergoing primary percutaneous coronary intervention (PCI) was conducted. Patients were randomized to 2 groups. Group 1 (n = 35) received intracoronary adenosine (1 to 2 mg) with a hand injection through the guiding catheter 2 times: immediately after crossing the lesion of the infarct-related artery with guidewire and then after the first balloon inflation. Group 2 (n = 35) received placebo. The baseline clinical and angiographic characteristics of the 2 groups were similar. Percutaneous coronary intervention resulted in Thrombolysis In Myocardial Infarction grade 3 flow after PCI in 32 patients (91.4%) in the adenosine group and 27 patients (77.1%) in the placebo group (p = 0.059). Myocardial blush grade 3 was observed at the end of PCI in 23 patients (65.7%) in the adenosine group and 13 (37.1%) in the placebo group (p < 0.05). Resolution of ST-segment elevation (> 50%) was more frequently observed in the adenosine than in the placebo group: 27 (77%) versus 15 (43%), respectively (p < 0.01). In conclusion, intracoronary adenosine administration improved the angiographic and electrocardiographic results in patients with acute myocardial infarction with ST-segment elevation undergoing PCI. Adenosine administration seemed to be associated with a more favorable clinical course.  相似文献   

2.
目的观察腺苷对急性心肌梗死(AM I)患者行PC I后再灌注损伤心肌的保护作用。方法AM I患者分为腺苷组和生理盐水组,行PC I时一组冠脉内推注腺苷,一组推注生理盐水,并测定血浆SOD、MDA、CK-MB峰值。结果腺苷组MDA较生理盐水组低(5.01±0.80 vs 6.97±0.86,P<0.05),腺苷组SOD较生理盐水组高(80.70±3.23 vs 61.63±3.49,P<0.05),腺苷组CK-MB峰值较生理盐水组明显降低(123.6±84.3 vs186.1±92.2,P<0.05)。结论AM I患者行急诊PC I术时冠脉内应用腺苷能减轻心肌再灌注损伤。  相似文献   

3.
PTCA was performed in 28 patients with acute MI immediately after intracoronary streptokinase administration. Indications were failure to obtain reflow in 16 patients and high-grade residual stenosis in 12. PTCA was successful in 11 of 16 cases of streptokinase failure, increasing the overall reflow rate from 66% to 77%. PTCA reduced residual coronary stenosis by more than 20% in 9 of 12 cases in which streptokinase infusion was successful, with 1 acute reocclusion. The frequency of recurrent ischemic events in hospital was 76% in patients with a stenosis of 90% or greater after streptokinase infusion (no PTCA), 14% when residual stenosis was less than 90%, and 6% after successful PTCA. Late restenosis or reocclusion was documented in 5 of 11 PTCA cases (45%). Immediate PTCA after streptokinase administration produces increased clinical stability in hospital, but late restenosis is frequent.  相似文献   

4.
目的 评价冠状动脉内注射腺苷对急性心肌梗死(AMI)再灌注治疗后无复流的影响。方法 共62例行经皮冠状动脉介入治疗(PCI)的AMI患者,被随机分为对照组和腺苷组。以PCI后最终冠脉造影校正的心肌梗死溶栓试验血流帧数(corrected thrombolysis in myocardial infarction frame count,cTFC)为标准,当cTFC≥23时诊断为无复流。PCI前、后采集肘静脉血检测肌酸激酶同工酶(CK-MB)和超敏C反应蛋白(hsCRP)。比较两组无复流发生率及血浆心肌酶和炎症因子的变化。结果 腺苷组中无复流的发生率较对照组明显降低(P<0.05)。腺苷组CK-MB和hsCRP较对照组明显降低(P<0.05)。多元线性回归分析显示CK-MB、hsCRP与无复流显著相关(P<0.05)。结论 AMI患者冠脉内应用腺苷能有效降低无复流的发生,降低血浆心肌酶、炎症因子水平。  相似文献   

5.
目的通过对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术中的抽吸物成分进行病理分析,研究不同抽吸物成分与心肌水平再灌注的关系。方法连续入选STEMI并行急诊PCI的患者150例,其中男性96例,女性54例。术者根据术中情况进行血栓抽吸。抽吸物用福尔马林固定后24 h内送病理科,行光学显微镜检查。根据病理检查结果将患者分为3组:血栓组、斑块组、混合组。分析3组患者的临床情况。结果 150例患者中,因病变迂曲钙化抽吸导管不能通过病变处致抽吸失败的4例,抽吸后未见固态物质未送病理检查的15例。资料完整者131例,其中男性87例,女性44例。抽吸成功率87.33%。3组患者TMP分级02级的发生率:血栓组:43.86%(25/57),斑块组:14.81%(4/27),混合组:17.02%(8/47),多因素非条件Logistic分析结果显示,抽吸物病理结果为斑块成分是与急诊PCI术后心肌灌注水平关系密切的因素(OR:3.412,P=0.011)。结论 STEMI患者通过抽吸清除斑块成分对改善心肌灌注具有重要作用。  相似文献   

6.
Aggressive interventional therapy in acute myocardial infarction (AMI) is expensive, time-consuming and not without significant risk. To determine which patients are most likely to benefit from such therapy, the effects of patient age, reperfusion success, admission left ventricular (LV) function, infarct location, admission clinical class, time from onset of pain to reperfusion and admission electrocardiographic findings on the outcome of coronary reperfusion in AMI were assessed in 292 prospectively studied, sequential patients from August 1980 to January 1984. Two hundred ten patients received intracoronary streptokinase (SK) therapy on admission and 82 patients, who either refused the protocol or met exclusion criteria, served as control subjects. Patients older than 65 years showed little improvement in 1-year mortality risk and no significant improvement in LV function during hospitalization after treatment with intracoronary SK. The remaining patients, 178 treated with SK and 48 control, were well matched and served as the basis for further comparisons. In this subgroup of patients, reperfusion success was associated with improved survival and LV function (mortality rate 3%, vs 17% in control subjects; increase in ejection fraction [EF] 18% vs 4%). Patients with an EF of less than 45% on admission showed a 21 +/- 30% increase in EF, compared with an increase in control subjects of 8 +/- 19%, and a lower 1-year mortality rate than controls (6% vs 21%, p = 0.01). Patients with anterior AMI had a significant increase in EF in the SK group (22 +/- 31%) and lower mortality compared with control subjects (5% vs 25%, p = 0.003).(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

7.
目的:分析再灌注时间对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)后心肌灌注及近期预后的影响。方法:101例首发STEMI并行急诊PCI的患者按症状发作至再灌注的时间(t)分为3组:t≤3h为A组,37例;3h0.05)。B组及C组PCI术后MBG0/1(58.06%、57.58%)和ST段回落不全(STR<50%)的比例(51.61%、54.55%)均高于A组(32.43%和27.03%,P<0.05),B组与C组间MBG、STR无统计学差异(P>0.05)。B组及C组在30d随访期间的死亡率、Killip分级和心源性休克发生率均显著高于A组(P<0.05)。结论:在STEMI急诊PCI中,12h内不同时间组获得TIMI 3级血流的比例相同,但再灌注时间<3h的患者心肌组织灌注水平提高,近期预后较好。  相似文献   

8.
目的:分析再灌注时间对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)后心肌灌注及近期预后的影响. 方法:101例首发STEMI并行急诊PCI的患者按症状发作至再灌注的时间(t)分为3组:t≤3 h为A组,37例;3 h0.05).B组及C组PCI术后MBG0/1(58.06%、57.58%)和ST段回落不全(STR<50%)的比例(51.61%、54.55%)均高于A组(32.43%和27.03%,P<0.05),B组与C组间MBG、STR无统计学差异(P>0.05).B组及C组在30 d随访期间的死亡率、Killip分级和心源性休克发生率均显著高于A组(P<0.05). 结论:在STEMI急诊PCI中,12 h内不同时间组获得TIMI 3级血流的比例相同,但再灌注时间<3 h的患者心肌组织灌注水平提高,近期预后较好.  相似文献   

9.
A multivariate logistic regression equation was used to evaluate variables related to successful intracoronary thrombolytic therapy. One hundred seventeen patients with a totally occluded infarct-related artery were randomly given ostial infusions of urokinase or streptokinase in a blinded study. The opening rate was 57%. The agent used and time from onset of symptoms to beginning of treatment did not significantly influence opening rate (p greater than .25). The site of occlusion was a strong predictor of opening rate (p = .0004). The anterior descending coronary artery was successfully opened more frequently than the left circumflex or right coronary artery (p = .012). Presence of collaterals adversely affected the recanalization rate in all groups (p = .0004). These variables had an additive effect on the probability of opening. Patients with proximal anterior descending occlusion and no collaterals had a 90% recanalization rate, while those with distal occlusions in vessels other than the anterior descending and with collaterals had only a 24% chance for reperfusion. Thus location of occlusion and presence or absence of collaterals may strongly influence opening rates.  相似文献   

10.
目的探讨急性ST段抬高性心肌梗死(STEMI)急诊经皮冠状动脉介入治疗(PCI)时冠状动脉内应用维拉帕米对冠状动脉灌注、心肌灌注及临床预后的影响。方法本研究为前瞻性、随机、双盲、对照性临床研究。连续性入选99例STEMI拟行急诊PCI的患者,随机分为维拉帕米组与对照组。在支架释放后即刻,维拉帕米组在靶血管内注入维拉帕米200μg,对照组在靶血管内注入肝素生理盐水,比较两组PCI术前、术后和冠状动脉内注药后的冠状动脉灌注和心肌灌注的差别。冠状动脉灌注以心外膜TIMI血流(TFG)和校正的TIMI血流帧数计数(CTFC)来评价。心肌灌注以TIMI心肌灌注分级(TMPG)和心肌灌注显影(MBG)来评价。并比较两组在PCI术后1周心脏彩色超声结果、住院期间以及随访期间主要心脏不良事件(MACE)发生率上的差别。结果最终91例患者有完整资料,其中维拉帕米组47例,对照组44例,两组临床基本特征和造影特征相仿。维拉帕米组和对照组在术前和支架释放后即刻冠状动脉灌注和心肌灌注各指标差异均无统计学意义(P〉0.05)。冠状动脉内注入维拉帕米后,维拉帕米组的CTFC、TFG、MBG、TMPG均较对照组有显著改善,分别为CTFC:27.1±14.2比39.0±23.8,P=0.011;TFG≥2级:100%比90.9%,P=0.035;MBG≥2级:91.5%%比75.5%,P=0.034;TMPG≥2级:89.4%比72.7%,P=0.042。维拉帕米组和对照组PCI术后1周时左室射血分数(63.4%±8.2%比63.5%±10.3%,P=0.578)、院内MACE发生率(4.3%比9.1%,P=0.613)和3个月MACE发生率(23.9%比22.7%,P=0.894)差异均无统计学意义。结论STEMI患者急诊行PCI治疗时,冠状动脉内应用维拉帕米可显著改善冠状动脉灌注和心肌灌注水平,但未观察到其对急诊PCI术后心室重构和短期临床预后的显著影响。  相似文献   

11.
目的探讨急性ST段抬高心肌梗死(STEMI)患者接受经皮冠状动脉介入术(PCI)治疗中,冠状动脉(冠脉)内应用血小板糖蛋白Ⅱb/IIIa(GPⅡb/Ⅲa)受体阻断药替罗非班对冠脉灌注、心肌灌注及临床预后的影响。方法连续入选87例发生急性STEMI并行急诊PCI的患者,入选患者随机分为冠脉内应用替罗非班组(冠脉组,n=45)与静脉内应用替罗非班组(静脉组,n=42)。冠脉组在支架释放后即刻在冠脉内3min注入替罗非班12μg/kg作为负荷量,随后以0.15μg/(kg·min)静脉维持24~48h;静脉组在支架释放后3min内静脉注入替罗非班12μg/kg作为负荷量,随后以0.15μg/(kg·min)静脉维持24~48h;术后随访3个月。比较两组患者PCI术后即刻梗死相关血管的TIMI血流分级(TFG)、校正的TIMI血流帧数计数(CTFC)、TIMI心肌灌注分级(TMPG)及心肌灌注显影分级(MBG);并比较两组PCI术后1周心脏超声指标、住院期间以及随访期间主要心脏不良事件发生率。结果 PCI术后即刻两组TFG、CTFC、TMPG、MBG均无显著差异(P均〉0.05),给予替罗非班冠脉内或静脉内给药后,两组TFG、CTFC、MBG、TMPG指标均较未给药前显著改善,冠脉给药组TFG、CTFC优于静脉给药组,差异有统计学意义(P〈0.05~0.01)。两组PCI术后1周心超结果(LVEF、LVEDD、LVESD)未见显著差异(P〉0.05);两组院内MACE事件发生率未达到统计学差异(P〉0.05),1月和3月随访期MACE发生率两组亦未见显著差异(P〉0.05)。结论 STEMI行急诊PCI治疗的患者,冠状动脉内应用替罗非班可显著地改善梗死相关血管的微循环血流,患者耐受性好,安全性高。  相似文献   

12.
目的:评价抽吸导管在急性心肌梗塞(AMI)介入治疗过程中应用的效果.方法:选择2009年1月至2010年3月间AMI患者共68例.其中应用抽吸导管及冠状动脉介入治疗(PCI)的患者33例,为血栓抽吸+PCI组;另有常规PCI对照组,35例.比较两组造影结果、临床预后及心肌梗塞溶栓(TIMI)血流分级.结果:抽吸+PCI...  相似文献   

13.
目的:探讨经皮冠状动脉内支架置入术(PCI)治疗急性ST段抬高型心肌梗死(STEMI)的临床疗效。方法:总结165例急性心肌梗死(AMI)患者的PCI临床资料。结果:入选的165例AMI患者中单支病变45例(27.3%),双支病变49例(29.7%),三支或三支以上病变71例(43.0%)。165例患者行PCI,成功率98.8%,共置入支架205枚。梗死相关血管为前降支(LAD)90例(54.5%),置入支架112枚;左回旋支(LCX)21例(12.7%),置入支架23枚;右冠脉(RCA)54例(32.7%),置入支架70枚。PCI术前出现心源性休克者18例(10.9%),2例于术后死亡。结论:急性心肌梗死行经皮冠状动脉内支架置入术疗效肯定。  相似文献   

14.
目的:分析在急性ST段抬高型心肌梗死(STEMI)急诊行经皮冠状动脉介入治疗(PCI)中应用抽吸导管对心肌再灌注影响.方法:首次STEMI行PCI患者80例,随机分为试验组(41例,应用抽吸导管后再行PCI),对照组(39例,直接行PCI).比较2组术后即刻计算校正TIMI计帧数和心肌Blush分级、术中慢复流现象、心电图90 min ST段下降率.在术后24 h、1周时应用心肌声学造影计算灌注对比积分指数(CSI)、室壁运动积分指数(WMSI).结果:PCI后试验组的校正TIMI计帧数明显低于对照组,Blush分级≥2级获得率高于对照组,慢复流现象减少;再通后90 min心电图相关导联ST段下降率试验组明显大于对照组(P<0.05).同时在研究的每一个时点,试验组CSI、WMSI较对照组明显降低(P<0.05).结论:在STEMI急诊行PCI中应用抽吸导管可改善梗死相关血管前向血流情况,改善心肌再灌注,减少无复流现象.  相似文献   

15.
We assessed the effect of impaired myocardial blush after primary coronary intervention (PCI) on left ventricular remodeling in patients with ST-segment elevation myocardial infarction (STEMI). The study population consisted of 145 patients with first anterior STEMI that was treated successfully (Thrombolysis In Myocardial Infarction grade 3 flow) with PCI. Left ventricular remodeling was defined as an increase of > or =20% in end-diastolic volume based on repeated echocardiographic measurements in patients. The study population was divided into 2 groups according to the presence (myocardial blush grade [MBG] 2 to 3, n = 86) or absence (MBG 0 to 1, n = 59) of myocardial reperfusion. Left ventricular remodeling appeared in 21% of the entire study group. Poor myocardial blush after PCI was associated with an increased rate of remodeling compared with good myocardial reperfusion (32% vs 14%, hazard ratio 2.308, 95% confidence interval [CI] 1.21 to 4.39, p=0.014). Symptoms of heart failure were observed significantly more often in patients with MBG 0 to 1 (35.6% vs 18.6%, p = 0.032) than in patients with MBG 2 to 3. In multivariate analysis, only age (odds ratio 0.96, 95% CI 0.92 to 0.99, p = 0.02) and MBG 0 to 1 (odds ratio 3.15, 95% CI 1.35 to 7.31, p = 0.008) were associated with left ventricular dilation. In conclusion, impaired microvascular reperfusion is associated with left ventricular remodeling and development of congestive heart failure in patients with anterior STEMI that is treated with primary coronary angioplasty.  相似文献   

16.
目的 评价急性心肌梗死(AMI)患者急诊直接经皮冠状动脉介入治疗术(PCI)中冠脉内应用血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班对术后心肌灌注和6个月随访结果的影响.方法 将178例接受急诊直接PCI治疗的AMI患者随机分为替罗非班组和对照组,比较两组术后即刻病变血管TIMI分级、校正的TIMI计帧数、心肌灌注TMP分级、心电图ST段下降程度,检测术后及6个月随访时NT-proBNP水平,超声心动图测定术后1周及6个月心脏射血分数,记录6个月内心脏主要不良事件.结果 两组术后TIMI 3级获得率无统计学差异,但替罗非班组校正的TIMI计帧数明显低于对照组,术后心肌灌注TMP分级3级血流者显著高于对照组,术后90 min心电图相关导联ST段明显回落者较对照组多,术后NT-proBNP 水平较对照组显著降低;随访6个月时NT-proBNP明显低于对照组,心脏射血分数明显高于对照组(P均<0.05).两组住院期间及6个月内主要心血管事发生率有统计学差异(P<0.05).结论 AMI患者急诊直接PCI术中冠脉内应用替罗非班安全有效,可显著改善PCI术后的心肌灌注及临床预后.  相似文献   

17.
目的探讨冠状动脉内注射地尔硫卓治疗直接经皮冠状动脉介入术(PCI)无复流的疗效。方法对23例直接PCI无复流患者给予梗死相关冠脉(IRA)内推注地尔硫卓2-4mg,分别于推注地尔硫卓前及推注后5min,用校正的心肌梗死溶栓治疗临床实验(TIMI)帧数(Corrected TIMI FrameCount,CTFC)评价IRA血流情况。结果23例无复流患者于IRA内注入地尔硫卓后CTFC由(60.45±12.10)帧降至(30.03±8.20)帧(P〈0.001),其中17例(复流组)IRA血流恢复至TIMI3级,6例(无复流组)IRA血流未恢复,有效率73.91%。结论冠脉内注射地尔硫卓治疗直接PCI无复流能有效地恢复患者IRA血流,可作为治疗无复流的一种方法。  相似文献   

18.
目的:评价血栓抽吸联合冠状动脉内注射替罗非班,在急性ST段抬高性心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)中的疗效。方法:回顾性分析急性STEMI行直接PCI术患者124例,术中使用血栓抽吸联合冠状动脉内推注替罗非班的56例患者做为观察组,以同期行常规直接PCI术的STEMI患者68例做为对照组。评估PCI术后即刻心肌梗死溶栓试验(TIMI)血流分级、TIMI心肌组织灌注分级(TMPG)及矫正的TIMI帧数(cTFC)、PCI术中无复流的发生率、直接支架置入率、PCI术后90min完全ST段回落率、肌酸激酶同工酶(CK-MB)和肌钙蛋白T(TnT)峰值、PCI术后7d左心室射血分数(LVEF)、住院期间和PCI术后3个月内主要心脏不良事件(MACE)发生率。结果:与对照组比较,观察组PCI术后即刻TIMI 3级及TMPG 3级血流比例更高(分别为94.6%∶80.9%,91.1%∶73.5%,P<0.05);cTFC帧数更少[(44.1±16.7)帧∶(57.1±23.1)帧,P<0.01];无复流发生率低(5.4%∶19.1%,P<0.05);直接支架置入率高(21.4%∶8.8%,P<0.05);PCI术后90min完全ST段回落率高(85.7%∶67.6%,P<0.05);CK-MB和TnT峰值低[分别为(172.4±45.6)U/L∶(201.7±39.5)U/L,(5.46±1.82)ng/L∶(6.59±1.97)ng/L,P<0.01];PCI术后7dLVEF高[(56.3±7.8)%∶(52.7±6.8)%,P<0.01]。观察组住院期间MACE少于对照组(14.3%∶26.5%),但差异无统计学意义,而PCI术后3个月内MACE亦少于对照组(26.8%∶44.1%),且差异有统计学意义(P<0.05)。结论:血栓抽吸联合冠状动脉内注射替罗非班可以增加急性STEMI患者直接PCI术中的冠状动脉血流和心肌组织灌注,减少无复流发生,减少心肌坏死,改善心功能和预后。  相似文献   

19.
目的:评价冠状动脉内应用山莨菪碱对急性心肌梗死(AMI)经皮冠状动脉介入治疗(PCI,含经皮冠状动脉腔内成形术和支架置入术)后梗死相关动脉(IRA)缓再血流现象(slowreflowphenomenon,SRP)的疗效及其安全性。方法:121例AMI直接PCI后再通的IRA存在SRP患者21例,先以硝酸甘油200μg冠状动脉内注入(确认SRP)作为对照,10min后继以冠状动脉内注入山莨菪碱500μg(2min内),于给药后1、3、10min行冠状动脉造影(CAG)。应用Gibon的TIMI血流计帧法和QCA测量系统分别行硝酸甘油和山莨菪碱冠状动脉内给药后不同时间点IRA再通后血流速率帧数和管腔直径的定量分析比较。结果:①术后基础对照与硝酸甘油给药1、3、10min时CAG血流帧数比较无明显变化(P>0.05);山莨菪碱给药后1、3和10min时CAG血流帧数分别较给药前减少58.3%,56.2%和54.6%(均P<0.01),平均TIMI血流增加从(1.76±0.43)级到(2.71±0.46)级,P<0.05;②冠状动脉内给予山莨菪碱后3min时开通IRA中段管径亦较前略有增加[(3.2±0.4)mm∶(3.4±0.5)mm,P>0.05];③山莨菪碱冠状动脉内给药后10min内连续监测冠状动脉内压、外周血压、PR间期、QT间期和QRS时限各参数与给药前比较差异均无统计学意义(P>0.05)。心率较用药前增加了15~19次/min,但未引起严重的心动过速和心律失常。结论:冠状动脉内应用山莨菪碱500μg可改善AMI直接PCI后SRP,且安全易行,可作为治疗IRA开通后SRP的有效药物之一。  相似文献   

20.
目的:观察稳心颗粒对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗术(PCI)中再灌注心律失常(RA)的影响。方法:选择符合诊断标准并有直接PCI指征的AMI患者105例,随机分为治疗组及对照组,对照组在常规药物治疗上行直接PCI,治疗组在上述治疗上加用稳心颗粒,观察术中、术后RA的发生情况。结果:治疗组RA发生率(36.2%)明显低于对照组(72.3%),2组比较差异有统计学意义(P<0.01)。结论:稳心颗粒对RA尤其是室性心律失常有较好治疗和预防作用。  相似文献   

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