血栓抽吸导管联合经抽吸导管冠状动脉内注射替罗非班在急性心肌梗死急诊介入中应用的临床研究

目的比较对急性ST段抬高型心肌梗死（STEMI）患者行直接经皮冠状动脉介入（PCI）手术中应用血栓抽吸导管联合经抽吸导管与经指引管冠状动脉内注射替罗非班和硝酸甘油的疗效。方法选择因STEMI行直接PCI并于术中应用DiverCE血栓抽吸导管联合经抽吸导管冠状动脉内推注替罗非班和硝酸甘油的患者34例作为抽吸管组，以基础临床资料和冠状动脉影像特征相似并直接PCI中应用血栓抽吸导管联合经指引管冠状动脉内注射上述药物的33例患者作为指引管组，观察临床疗效。结果抽吸管组在注药前后血压变化差异无统计学意义（P〉0．05），但指引管组血压变化差异有统计学意义（P〈0．01），术后肌钙蛋白、血BNP值、CK-MB峰值、CK-MB峰值时间、TIMI3级血流及梗死相关血管（IRA）慢血流发生率均优于指引管组（t值分别为3．92、4．70、3．39、7．17，P均〈0．01；X2值分别为3．877、3．876，P均〈0．05）。两组术后l周时左心室射血分数（LVEF）、左心室舒张末期内径（LVEDd）、左心室收缩末期内径（LVESd）比较差异均无统计学意义（P均〉0．05），但术后1个月抽吸管组LVEF、LVEDd、LVESd均优于指引管组（t值分别为5．99、4．53、8．12，尸均〈0．01），而术后2hST回落率、1个月MACE发生率比较差异无统计学意义（P均〉0．05）。结论STEMI患者行直接PCI过程中与经指引导管冠状动脉内注药相比，应用血栓抽吸导管联合经抽吸导管冠状动脉内推注替罗非班和硝酸甘油可减少慢血流的发生，改善心肌再灌注水平及左心室功能。

Clinical application of thrombus aspiration catheters combined with intracoronary tirofiban injection through the aspiration catheter during emergency percutaneous coronary intervention in acutemyocardial infarction

Objective To compare the efficacy of thrombus aspiration catheter combined with intracoronary tirofi.ban and nitroglycerol injection through the aspiration catheter versus the guiding catheter during primary percutaneous coronary intervention （PCI） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods Thirty-four patients with STEMI undergoing primary PC1 and receiving thrombus aspiration catheter combined with intracoronary tirofiban and nitroglycerol injection through the aspiration catheter were enrolled as the aspiration group （ n = 34）, and those who had similar coronary angiography results and basic characteristics but receiving thrombus aspiration catheter combined with intracoronary tirofiban and nitroglycerol injection through the guiding catheter were served as the guiding group （ n = 33 ）. The outcomes of the two groups were observed and compared. Results There was no significant change of blood pressure between before and after injection in the aspiration group （P 〉 0. 05 ）, but the change of blood pressure was significant after injection compared with before injection in the guiding group （ P 〈 0. 01 ）. The cTn-I, BNP, peak-value of CK-MB,peak-time of CK-MB, TIMI grade 3 flow, slow-reflow in IRA after PCI in the aspiration group were superior to those in the guiding group （ t = 3.92, P 〈 0.01 ; t = 4. 70,P 〈 0. 01 ; t = 3.39, P 〈 0.01 ; t = 7. 17, P 〈 0. 01;X2 = 3. 877 ,P 〈 0. 05;X2 = 3. 876, P 〈 0. 05 ）. LVEF, LVEDd and LVESd after 1 month in the aspiration group were superior to those in the guiding group （t = 5.99,P 〈 0. 01 ;t = 4.53,P 〈 0.01 ;t = 8.12, P 〈 0. 01 ）, but no significant differences of LVEF, LVEDd, LVESd were found after 1 week resolution of sum of ST-segment elevation and the MACE rates after PCI were found between the two group （ P 〉 0. 05 ） . Conclusion Application of thrombus aspiration catheter combined with intracoronary tirofiban injection through the aspirationcatheter is more effective than through the guiding catheter in patients with Acute ST-segment elevation myocardial infarction, which could decrease slow-reflow phenomenon and improve re-perfusion and left ventricular function with better clinical outcomes.