急性心肌梗死急诊介入中应用血栓抽吸联合冠脉内注射盐酸替罗非班的效果分析(1)
[摘要]目的 探讨血栓抽吸联合冠脉内注射盐酸替罗非班在急性心肌梗死急诊介入中的应用效果。方法 选择2013年1月～2015年12月行急诊冠状动脉介入(PCI)治疗的急性ST段抬高心肌梗死患者48例，冠状动脉造影证实明显血栓负荷，根据治疗方式不同分为两组，其中观察组20例介入治疗前给予血栓抽吸及冠状动脉内注射替罗非班，对照组28例仅行PCI术。观察临床疗效及安全性。结果 观察组在梗死血管的TIMI3级血流、术后2 h ST段回落百分比、酶峰值时间方面均优于对照组(P<0.05)，IRA无复流或慢血流发生率低于对照组(P<0.05)。3个月时，观察组LVEF、LVEDd均优于对照组(P<0.01)，住院期间观察组MACE发生率低于对照组(P<0.05)，两组出血发生率差异无统计学意义(P>0.05)。结论 血栓抽吸联合盐酸替罗非班治疗急性ST段心肌梗死可减少“无复流”或“慢血流”的发生，改善心肌灌注，改善预后。
[关键词]血栓抽吸；冠脉内注射盐酸替罗非班；急性心肌梗死；急诊介入治疗
[中图分类号] R542.2+2 [文献标识码] A [文章编号] 1674-4721(2016)11(c)-0037-03
[Abstract]Objective To explore the application effect of thrombus aspiration combined with Tirofiban Hydrochloride for coronary injection in emergency intervention for acute myocardial infarction.Methods 48 patients with acute ST segment elevation and given emergency percutaneous coronary intervention (PCI) from January 2013 to December 2015 were selected.Coronary angiography showed significant thrombus burden，and patients were divided into two groups according to treatment method.Observation group (n=20) was given thrombus aspiration combined with Tirofiban Hydrochloride for coronary injection while control group (28 cases) was given only PCI.Clinical efficacy and safety was observed.Results In observation group，TIMI3 level of blood flow，the percentage of ST segment fell after 2 h operation and enzyme peak time were better than those of control group (P<0.05).The incidence rate of no reflow or slow flow of IRA was lower than that of control group (P<0.05).At 3 months，LVEF and LVEDd in observation group were better than those of control group (P<0.01)，and during hospitalization，the incidence rate of MACE in observation group was lower than that of control group (P<0.05).The incidences of bleeding of the two groups was not statistically significant (P>0.05).Conclusion Thrombus aspiration combined with Tirofiban Hydrochloride treating acute myocardial infarction with ST segment elevation can reduce no-reflow or slow flow，improve myocardial perfusion and improve the prognosis.
[Key words]Thrombus aspiration；Tirofiban Hydrochloride for coronary injection；Acute myocardial infarction；Emergency intervention treatment
急性心肌梗死是冠狀动脉缺氧、缺血所致的心肌坏死。临床常采取冠状动脉介入治疗，该方法的关键就是开通闭塞的冠状动脉，是急性ST段抬高心肌梗死的主要治疗方法[1-3]，但是仅使用冠状动脉介入治疗(PCI)治疗会使患者远端血管栓塞，冠状动脉出现“无复流”或“慢血流”现象，威胁患者的生命健康[4]。为改善这一现象，本文以我院患者为研究对象，探究血栓抽吸联合冠脉内注射盐酸替罗非班在急性心肌梗死急诊介入中的应用效果。
1资料与方法
1.1一般资料
以2013年1月～2015年12月行急诊PCI的急性ST段抬高心肌梗死48例患者为研究对象，所有患者均经过冠状动脉造影证实明显血栓负荷，确诊病情。依照治疗方法不同分为两组，其中观察组有患者20例，男11例，女9例，平均年龄为(56.81±6.32)岁；对照组有患者28例，男17例，女11例，平均年龄为(55.93±7.11)岁。两组患者在年龄、性别等一般资料方面差异无统计学意义(P>0.05)，具有可比性。 (刘睦胜)
[关键词]血栓抽吸；冠脉内注射盐酸替罗非班；急性心肌梗死；急诊介入治疗
[中图分类号] R542.2+2 [文献标识码] A [文章编号] 1674-4721(2016)11(c)-0037-03
[Abstract]Objective To explore the application effect of thrombus aspiration combined with Tirofiban Hydrochloride for coronary injection in emergency intervention for acute myocardial infarction.Methods 48 patients with acute ST segment elevation and given emergency percutaneous coronary intervention (PCI) from January 2013 to December 2015 were selected.Coronary angiography showed significant thrombus burden，and patients were divided into two groups according to treatment method.Observation group (n=20) was given thrombus aspiration combined with Tirofiban Hydrochloride for coronary injection while control group (28 cases) was given only PCI.Clinical efficacy and safety was observed.Results In observation group，TIMI3 level of blood flow，the percentage of ST segment fell after 2 h operation and enzyme peak time were better than those of control group (P<0.05).The incidence rate of no reflow or slow flow of IRA was lower than that of control group (P<0.05).At 3 months，LVEF and LVEDd in observation group were better than those of control group (P<0.01)，and during hospitalization，the incidence rate of MACE in observation group was lower than that of control group (P<0.05).The incidences of bleeding of the two groups was not statistically significant (P>0.05).Conclusion Thrombus aspiration combined with Tirofiban Hydrochloride treating acute myocardial infarction with ST segment elevation can reduce no-reflow or slow flow，improve myocardial perfusion and improve the prognosis.
[Key words]Thrombus aspiration；Tirofiban Hydrochloride for coronary injection；Acute myocardial infarction；Emergency intervention treatment
急性心肌梗死是冠狀动脉缺氧、缺血所致的心肌坏死。临床常采取冠状动脉介入治疗，该方法的关键就是开通闭塞的冠状动脉，是急性ST段抬高心肌梗死的主要治疗方法[1-3]，但是仅使用冠状动脉介入治疗(PCI)治疗会使患者远端血管栓塞，冠状动脉出现“无复流”或“慢血流”现象，威胁患者的生命健康[4]。为改善这一现象，本文以我院患者为研究对象，探究血栓抽吸联合冠脉内注射盐酸替罗非班在急性心肌梗死急诊介入中的应用效果。
1资料与方法
1.1一般资料
以2013年1月～2015年12月行急诊PCI的急性ST段抬高心肌梗死48例患者为研究对象，所有患者均经过冠状动脉造影证实明显血栓负荷，确诊病情。依照治疗方法不同分为两组，其中观察组有患者20例，男11例，女9例，平均年龄为(56.81±6.32)岁；对照组有患者28例，男17例，女11例，平均年龄为(55.93±7.11)岁。两组患者在年龄、性别等一般资料方面差异无统计学意义(P>0.05)，具有可比性。 (刘睦胜)