冠状动脉内注射替罗非班对急性ST段抬高型心肌梗死患者介入治疗后无复流现象的影响

目的评价冠状动脉内注射替罗非班对急性ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉介入治疗（PCI）后无复流发生率的影响。方法将120例STEMI患者分为替罗非班组（替罗非班＋直接PCI，60例）和对照组（直接PCI，60例）。PCI术中根据TIMI血流分级、TIMI计帧法（cTFC）评价冠状动脉血流。术后24h进行实时心肌声学造影检查，计算心肌灌注缺损计分指数（CSI）及室壁运动计分指数（WMSI）。分析术后1h2组患者心电图sT段偏移总和比值（sumSTR）的变化。结果替罗非班组TIM13级血流显著多于对照组（P〈0．05），而cTFC显著低于对照组（P〈0．05）；替罗非班组与对照组相比CSI（1．23±0．33．1．38±0．43，P〈0．05），WMSI（1．52±0．39：1．70±0．38；P〈0．05）均显著降低；与对照组比较，替罗非班组术后1hsumSTR〉70％比例更高（P〈0．05）。结论冠状动脉内注射替罗非班能改善STEMI患者PCI术后心肌血流，防止无复流的发生。

Influence of intracoronary tirofiban on no-reflow phenomenon after percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction SU

Objective To evaluate the influence of intracoronary tirofiban on the incidence of no reflow after percutaneous coronary intervention ( PCI ) in patients with acute ST segment elevation myocardial infarction ( STEMI ).Methods 120 STEMI patients were divided into tirofiban group ( tirofiban and direct PCI,n =60 ) and control group ( direct PCI,n =60 ).During PCI,coronary flow was evaluated according to TIMI flow grading and corrected TIMI frame count ( cTFC ).The changes in sum ST segment resolution ( sumSTR ) were compared one hour after PCI; myocardial perfusion defect score index ( CSI ) and wall motion score index ( WMSI ) were computed 24 hours after PCI according to myocardial contrast echocardiography ( MCE ).Results The blood flow of TIMI grade 3 was greater in tirofiban group than in the control group ( P ＜ 0.05 ) and cTFC was significantly lower in tirofiban group than in the control group ( P ＜ 0.01 ); CSI and WMSI were was significantly lower in tirofiban group than in the control group ( 1.23 + 0.33 vs.1.38 + 0.43,1.52 + 0.39 vs.1.70 ± 0.38; P＜ 0.05 );,the ratio of sumSTR ＞ 70％ was significantly higher in the tirofiban group than in the control group ( P ＜ 0.05 ).Conclusions Intracoronary tirofiban can improve myocardial blood flow in STEMI patients after PCI and can prevent the occurrence of no reflow.