急性心肌梗死手动血栓抽吸后相关动脉内应用替罗非班的研究

目的：评价急性ST段抬高性心肌梗死（STEMI）患者在急诊经皮冠状动脉介入术（PCI）中应用手动抽吸血栓后经抽吸导管在梗死相关动脉内应用替罗非班的有效性和安全性。方法：选择在我院行急诊PCI手术的心肌梗塞溶栓（TIMI）血栓积分3级以上的STEMI患者96例。随机分为血栓抽吸联合梗死相关动脉内注射盐酸替罗非班组（研究组）46例，常规PCI及静脉滴注盐酸替罗非班组（常规治疗对照组）50例。分析术后两组间造影结果、ST段回落率、肌钙蛋白I（TnI）、左室射血分数（LVEF）水平和主要不良心脏事件（MACE）发生率。结果：与常规治疗对照组术后比较，研究组术后校正TIM／血流计帧（CTFC）达到正常血流率（78．0％比93．5％）、心肌染色分级（MBG）达到三级的比例（76．0％比95．7oA）和LVEF[（49．67±7．976）％比（57．01±7．484）％]明显升高（P〈0．05或〈0．01）；cTnI峰值[（65．74土27．223）ng／m[比（49．91±19．442）ng／m1]、MACE发生率（22．0％比6．5％）明显降低（P〈O．01，d0．05）。两组住院期间均未发生出血事件。结论：急诊PCI术中应用手动血栓抽吸并在梗死相关动脉内注射替罗非班较常规治疗效果更好，而且安全。

Study for application of tirofiban in intra-infarct-related artery after manual thrombus aspiration in patients with acute myocardial infarction

Objective： To investigate validity and safety of intra- infarct- related artery （IRA） application of tirofi- ban after manual thrombus aspiration during emergency PCI in patients with acute ST elevation myocardial infarc- tion （STEMI）. Methods： A total of 96 STEMI patients, who underwent emergency PCI in our hospital and their thrombus intergration of thrombolysis in myocardial infarction （TIMI） was over grade 3, were enrolled. The pa-tients were randomly divided into thrombus aspiration ± intra- IRA application of tirofiban group （study group, n = 46） and routine PCI ± intravenous infusion of tirofiban group （routine therapy control group, n = 50）. Results of angiography, ST segment regression rate, levels of troponin I （cTnI） and LVEF and incidence rate of major adverse cardiovascular events （MACE） were analyzed in two groups after operation. Results： Compared with control group after operation, there were significant increase in rate of corrected TIMI frame count （CTFC） achieving normal blood flow （78.0% vs. 93.5 % ）, ratio of myocardial blush grade （MBG） achieving grade 3 （76.0% vs. 95.7%） and LVEF （ （49.67 ± 7. 976） % vs. （57.01 ± 7. 484） %], P〈0.05 or〈0.01, and significant decrease in cTnI peak value [ （65.74 ± 27. 223） ng/ml vs. （49.91 ± 19. 442） ng/ml] and incidence rate of MACE （22.0% vs. 6.5%） in study group （P〈0.01, 〈0.05）. No bleeding event occurred in both groups during admission. Conclusion： Intra-infarct- related artery application of tirofiban after manual thrombus aspiration during emergency PCI possesses more effect compared with routine therapy and is safe.