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目的观察冠状动脉内直接注射替罗非班对ST段抬高急性心肌梗死(STEMI)行急诊经皮冠状动脉介入治疗术(PCI)术中出现慢血流现象的临床疗效。方法 82例急诊PCI术中出现慢血流现象患者,根据是否冠脉内注射替罗非班分为替罗非班组(36例)和对照组(46例)。比较两组术后TIMI血流、术后90 min ST段回落、住院期间及1年随访左心射血分数(LVEF)及不良心血管事件(MACE)。结果替罗非班组术后TIMI分级0、1、2、3级例数分别为1、3、4、28例,对照组分别为2、5、12、27例;替罗非班组与对照组术后ST段回落的例数分别为30、18例;替罗非班组术前LVEF为(45.79±7.80)%,术后为(54.29±5.80)%,对照组分别为(48.15±7.59)%、(51.09±5.92)%;替罗非班组患者在住院期间MACE为4例,随访1年的MACE为8例,对照组分别为10、13例。替罗非班组患者术后TIMI血流恢复情况明显优于对照组、ST段回落明显高与对照组(P<0.05);与术前相比,两组患者术后1年LVEF均提高,且替罗非班组改善情况优于对照组(P<0.05);两组术后的MACE发生率比较差异无统计学意义(P>0.05)。结论急诊PCI术中出现慢血流时,冠状动脉内注射替罗非班可改善心肌灌注,加快心电图ST段回落,改善增加LVEF。
Objective To observe the clinical effect of direct intracoronary injection of tirofiban on patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing emergent percutaneous coronary intervention (PCI). Methods Eighty-two patients with slow blood flow during PCI were divided into two groups: Tirofiban (36 cases) and control group (46 cases) according to whether Tirofiban was given intracoronary injection. The postoperative TIMI flow was compared between the two groups. The ST segment was dropped 90 min after the operation, and left ventricular ejection fraction (LVEF) and adverse cardiovascular events (MACE) were observed during hospitalization and one year follow-up. Results Tirofiban postoperative TIMI grading 0, 1, 2, 3 cases were 1,3,4,28 cases, the control group were 2,5,12,27 cases; Tirofiban group and control group The number of postoperative ST-segment depression was 30 and 18, respectively. The preoperative LVEF was (45.79 ± 7.80)% in the tirofiban group, (54.29 ± 5.80)% in the control group and (48.15 ± 7.59)% in the control group , (51.09 ± 5.92)% respectively; MACE in hospitalized patients in tirofiban group was 4 cases, MACE in 8 cases was followed up for 1 year, and the control group was 10 and 13 cases respectively. Tirofiban group patients with postoperative TIMI blood flow recovery was significantly better than the control group, ST segment depression was significantly higher compared with the control group (P <0.05); compared with the preoperative, two groups of patients 1 year after LVEF were increased, and Tirofiban improved better than the control group (P <0.05). There was no significant difference in the incidence of postoperative MACE between the two groups (P> 0.05). Conclusions Coronary intracoronary injection of tirofiban can improve myocardial perfusion during emergent PCI with slow blood flow, speed up the ST segment depression and improve the LVEF.