硝普钠联合欣维宁对 PCI 术中无复流的疗效观察

目的：观察冠状动脉内注射硝普钠和欣维宁对经皮冠状动脉介入治疗（PCI）术中无复流的治疗效果。方法：将PCI术中发生无复流现象的患者63例随机分为硝普钠与欣维宁联合用药组（A组，n=32）和欣维宁组（B组，n=31）。2组患者使用相同的PCI手术方法，对术中判断为无复流的患者，A组给予冠状动脉内注射硝普钠和欣维宁，B组注射欣维宁。观察2组患者用药后即刻及用药后5min的造影图像，分析TIMI血流分级和校正的TIMI帧计数（CTFC），同时观察术中血压变化，术后1周氨基末端B型利钠肽（NT—proBNP）、左室射血分数（LVEF）及术后半年主要心血管事件（MACE）发生率和再次住院率。结果：A组患者TIMI3级获得率、CTFC值均优于B组（P〈0．05），术后1周A组患者NT-proBNP低于B组而LVEF明显高于B组（P〈0．05），术后6个月主要心血管事件发生率差异无统计学意义（P〉0．05），但A组患者再次住院率明显低于B组（P〈0．05）。结论：冠状动脉内注射硝普钠联合欣维宁能明显改善PCI术中的无复流现象，并可能部分改善患者的远期预后。

Clinical observation of intracoronary nitroprusside and tirofiban for the prevention of no-reflow phenomenon following percutaneous coronary intervention

Objective： To evaluate the effect of intracoronary nitroprusside and tirofiban on the prevention of no-reflow phenomenon following percutaneous coronary intervention. Methods： Sixty-three patients with no- reflow phenomenon following PCI were randomly divided into nitroprusside combined tirofiban group （group A, n= 32） and tirofiban group （group B, n=31）. The angiographic results including thrombolyses in myocardial infarction （TIMI） and corrected TIMI frame count （CTFC）,the blood pressure during PCI, NT-proBNP and left ventricular ejection fraction （LVEF） after PCI for 1 week, incidence of major adverse cardiovascular events （MACE） and the hospitalization rate due to cardiovascular events within 6 months were observed in both groups. Results： The incidence of final TIMI-3 flow was much higher and final corrected TIMI frame count （CTFC） decreased significantly in group A than in group B （P 〈 0.05）.Compared with group B, the blood pressure did not decrease significantly in group A （P 〉 0.05）. NT-proBNP was lower and LVEF was higher in group A than in group B after PCI for 1 week （P 〈 0.05）. There was no significant difference in MACE between two groups in 6 months follow-up （P 〉 0.05）. The hospitalization rate due to cardiovascular events （AMI, heart failure, arrhythmia, et al.） in group A was significantly lower than that in group B（P 〈 0.05）. Conclusion： Intracoronary nitroprusside combined tirofiban can prevent no-reflow phenomenon effectively during PCI and lead to better prognosis.