经两种导管注射地尔硫卓处理急诊PCI术中无复流现象的疗效比较

目的:观察急诊经皮冠状动脉介入治疗(PCI)术中出现无复流现象后,经微导管向远端血管床注射地尔硫卓的治疗效果。方法:选择PCI治疗中存在“无复流”现象的患者41例为研究对象,其中20例入选导引导管组,经导引导管冠状动脉内注射地尔硫卓2.0 mg;21例入选微导管组,经微导管注射地尔硫卓2.0 mg至靶病变远端:10 min后复查冠状动脉造影,观察两组患者首次和手术结束前末次造影图像,评定冠状动脉血流心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)分级及TIMI心肌组织灌注分级(TMPG)、1周内住院期间主要心脏不良事件(MACE)事件。结果:2组均可改善PCI治疗后的“无复流”现象。微导管组手术结束前末次造影TIMIⅢ级比例明显高于导引导管组95%(20/21)vs.40%(8/20),P<0.05],而且手术结束前末次造影TIMI心肌组织灌注分级(TMPG)Ⅲ级亦较高(90%vs.35%,P<0.05),减少1周内住院期间MACE事件(5%vs.30%,P<0.05)。结论:与经导引导管相比,经微导管注射地尔硫卓明显改善急诊PCI术中无复流现象。

Comparative study of no-reflow during emergency percuteneous coronary intervention using diltiazem from microcatheter and guiding catheter

AIM: To study the effect of intra-microcatheter diltiazem on no-reflow phenomenon during percutaneous coronary intervention(PCI) for acute myocardial infarction(AMI).METHODS: Forty one patients with no-reflow phenomenon during PCI were included in this study.Patients were divided into guiding catheter group(diltiazem 2 mg injection from guiding catheter to target coronary,n=20) and microcatheter group(diltiazem 2 mg injection from microcatheter to far-end target lesions,n=21).Coronary angiography was rechecked 10 min after injection.Thrombolysis in myocardial infarction(TIMI) and TIMI myocardial perfusion grade(TMPG) of target coronary and 1-week MACE in hospital were assessed.RESULTS: No-reflow phenomenon was relieved in both groups.Patients treated with diltiazem from microcatheter were significantly higher than those treated with guiding catheter in the last contrastographic picture TIMI-3 flow degree(20 cases vs.eight cases,P<0.05).The microcatheter group had a higher rate of TMPG-3 in the last contrastographic picture after drug administration(20 vs.seven cases,P<0.05) and statistical difference was observed in 1-week MACE in hospital between groups(one case vs.six cases,P<0.05).CONCLUSION: Diltiazem injection from microcatheter achieves a better effect than injection from guiding catheter on no-reflow phenomenon during PCI for AMI patients.