冠脉内注射硝普钠对老年STEMI患者直接PCI预防无复流现象的疗效评价

目的 探讨冠状动脉内预防性注射硝普钠对老年ST段抬高型心肌梗死（STEMI）患者直接经皮冠状动脉介入治疗（pPCI）预防无复流的安全性与疗效。方法 将185例行pPCI的STEMI老年患者采用完全随机化方法分为对照组（93例）与硝普钠组（92例）。硝普钠组开通冠脉后立即注射硝普钠200 μg，对照组注射等量的生理盐水。比较2组患者术中无复流发生情况及术后肌钙蛋白T（cTnT）、估测射血分数（EF），住院期间及随访1年主要不良心血管事件（MACE）发生率，并分析无复流发生危险因素。结果 硝普钠组左心室射血分数（LVEF）及估测EF明显高于对照组，而cTnT及C-反应蛋白（CRP）明显低于对照组（P＜0.05）；硝普钠组无复流发生比例、支架植入数目明显低于对照组（P＜0.05），2组间梗死相关动脉分布、TIMI血流分级冠脉Gensini评分及SYNTAX评分差异均无统计学意义；住院期间2组MACE事件发生率差异无统计学意义，随访1年期间硝普钠组MACE事件发生率明显少于对照组（P＜0.05）。Logistic回归分析显示，未应用硝普钠、糖尿病、高SYNTAX评分为无复流发生的独立危险因素。结论 硝普钠可明显减少接受pPCI治疗的老年STEMI患者的无复流发生率，减少1年MACE事件发生率，且具有良好的安全性。

Curative effect of intracoronary injection of sodium nitroprusside on no-reflow phenomenon inelderly patients with STEMI treated by primary percutaneous coronary intervention

Objective To investigate the safety and efficacy of prophylactic injection of sodium nitroprusside inprimary percutaneous coronary intervention (pPCI) without reflow in elderly patients with ST segment elevation myocardialinfarction (STEMI). Methods A total of 185 elderly patients with STEMI were divided into sodium nitroprusside group (n=92) and control group (n=93) with completely randomized design. All patients were treated with pPCI. Sodium nitroprussidegroup received sodium nitroprusside 200 μg immediately after opening coronary artery. Control group received equal amountof physiological saline. The incidence of no-reflow, the levels of troponin T (cTnT) and ejection fraction (EF), the incidenceof major adverse cardiovascular events (MACE) during hospitalization and 1 year follow-up were compared between twogroups, and the risk factors of no-reflow were analyzed. Results In nitroprusside group, the incidence of no flow and cTnT,CRP, and the number of stent were significantly lower and LVEF, EF were significantly higher than those in control group(P＜0.05). There were no significant differences in HbA1c, infarct related artery (IRA), TIMI grade, Gensini score, SYNTAXscore and incidence of MACE during hospitalization between two groups (P＞0.05). In nitroprusside group, the incidence ofMACE in 1-year follow-up was significantly lower than that in control group (P＜0.05). Logistic regression analysis showedthat without injection of nitroprusside, diabetes and the high SYNTAX scores were independent risk factors for no reflow.Conclusion The application of sodium nitroprusside can significantly reduce the incidence of no flow and MACE in 1-yearfollow up in elderly patients with STEMI treated with pPCI，and which has good safety.