急性心肌梗死急诊介入治疗中替罗非班冠状动脉内注入对疗效的影响

目的探讨胰头癌侵犯门静脉联合血管重建的适应证和方法。方法对2001年5月-2004年12月收治的8例肿瘤侵犯门静脉的胰头癌患者，行胰头十二指肠联合门静脉切除及门静脉对端吻合血管重建的手术资料进行回顾性分析。全组均行联合肠系膜上静脉-门静脉切除，门静脉阻断时间为22～35min；同时清扫腹膜后重要血管周围的淋巴组织。结果手术后8例患者均顺利恢复。无胆、胰瘘、感染及出血、血栓发生。病理检查：切除肿瘤均为腺癌。切除血管内膜和胰腺边缘均无肿瘤浸润。随访时间6个月-4年，2例患者死于术后6～12个月。存活超过2年者4例。结论在门静脉-肠系膜上静脉侵犯小于3cm的选择性病例中施行联合切除血管的胰头癌根治术可提高其切除率，患者存活率有一定程度提高。

Effect of intracoronary tirofiban in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction

Objective To investigate the efficacy of intracoronary tirofiban during percutaneous coronary intervention(PCI)for patients with acute myocardial infarction(AMI).Methods Seventy-six consecutive AMI patients,treated with primary coronary angioplasty in 12 hours were enrolled.They were randomly divided into two groups:tirofiban group(39 cases)and control group(37 cases).Tirofiban group was treated with intracoronary timfiban during PCI and after the operation for 48 hours.Both of them were given heparin in PCI and aspirin,clopidogrel before PCI.At the end of PCI procedure,angiographic features such as TIMI flow grade and TIMI myocardial perfusion grade(TMPG)were analyzed.The difference of two groups in complication and major adverse cardiac events(MACE) was investigated.Results The myocardial reperfusion of tirofiban group was better than that of control groupTIMI grade 3 flow 94.9%(37/39) vs 78.4%(29/37),P<0.05;TMPG 3 grade 89.7%(35/39)vs 67.6%(25/37),P<0.05].There was no significant difference between two groups in bleeding complication.The occurrence of MACE in tirofiban group was less than that in control group7.7%(3/39)vs 18.9%(7/37),P<0.05].Conclusion Intracoronary tirofiban dunng primary PCI in patients with AMI can improve coronary flow and myocardial perfusion,and has no more bleeding and less MACE occurrence.