维拉帕米联合替罗非班对PCI术中无复流疗效观察

目的探讨冠状动脉内注射维拉帕米和（或）替罗非班对急性冠状动脉综合征（acute coronary syndrome,ACS）患者经皮冠状动脉介入治疗时无复流现象的影响。方法选择我院2009年12月～2011年4月在实施冠状动脉内介入治疗时出现靶血管的无复流现象的ACS患者,常规给予硝酸甘油冠脉内注射血流无明显改善共49例,按就诊顺序分为替罗非班组和维拉帕米联合替罗非班组,观察两组PCI术后TIMI血流情况。结果两组患者用药后TIMI血流均明显改善,维拉帕米联合替罗非班组比替罗非班组改善更为显著（P〈0.05）。结论无复流现象与靶血管远端的冠状动脉内微血栓及痉挛有关,冠状动脉内联合注射GPⅡb/Ⅲa受体阻断药替罗非班与钙拮抗剂维拉帕米较单独注射替罗非班疗效更确切,可明显改善术后相关动脉无复流现象。

Observation on the effects of tirofiban combined with velapamil on no-reflow of acute coronary syndrome following PCI

Objective To investigate the effects of intracoronary administration of tirofiban with velapamil on no-reflow of acute coronary syndrome （ACS）related artery following primary PCI. Methods A total of 49 patients with no-reflow of acute coronary syndrome related artery following primary PCI were enrolled from Dec 2009 to Apr 2011 and divided into the tirofiban with velapamil group and the tirofiban group. The TIMI flow of two groups after PCI were observed. Results Compared with before medication,both groups could improve TIMI flow,the tirofiban with velapamil group was better than tirofiban group （P〈 0.05）. Conclusion The no-reflow phenomenon during PCI is associated with vessel spasm and thrombosis in the coronary mi- crovasculature. Intracoronary administration of GPⅡb/Ⅲa receptor antagonist tirofiban combined with calcium antagonist velapamil can more significantly improve the post PCI no-reflow phenomenon than tirofiban without velapamil.