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目的:探讨冠状动脉内联合应用山莨菪碱和替罗非班对逆转急性心肌梗死(AMI)介入治疗后无再流的可行性、安全性及临床疗效。方法:行冠状动脉介入治疗的AMI患者252例,发生无再流47例,随机分为A组(替罗非班组)和B组(盐酸山莨菪碱联合替罗非班组),观察冠状动脉内SBP、DBP、MBP、HR、肺毛细血管楔压(PCWP)、左室舒张末期压力(LVEDP)、TIMI血流及TIMI血流计帧数的变化以及住院期间及术后1个月的主要心脏不良事件发生率。结果:A组冠状动脉内用药后SBP、DBP、MBP、HR、LVEDP及PCWP无明显变化,而B组用药后冠状动脉内SBP、DBP、MBP、HR明显升高(P<0.05或P<0.01),LVEDP及PCWP降低,但与用药前及A组比较差异无统计学意义;2组均明显改善TIMI血流及TIMI血流计帧数,B组效果更明显,均P<0.01。2组住院期间及术后1个月均无死亡、再次心肌梗死、再次血运重建、心绞痛等主要心脏不良事件发生。结论:冠状动脉内联合应用盐酸山莨菪碱和替罗非班可显著逆转AMI后无再流,不增加恶性心律失常和出血并发症的发生。
Objective: To investigate the feasibility, safety and clinical efficacy of anisodamine and tirofiban combined with intracoronary injection in the treatment of reversal of acute myocardial infarction (AMI) after interventional therapy. Methods: A total of 252 AMI patients undergoing coronary intervention were randomly divided into two groups: A group (tirofiban group) and B group (anisodamine hydrochloride combined with tirofiban group), and intracoronary Changes in SBP, DBP, MBP, HR, PCWP, LVEDP, TIMI flow, and TIMI flowmetry frames, as well as major cardiac and postoperative cardiac arrest Adverse event rate. Results: There was no significant change of SBP, DBP, MBP, HR, LVEDP and PCWP in group A after intracoronary administration, while SBP, DBP, MBP and HR in coronary arteries of group A were significantly increased (P <0.05 or P <0.01 ), LVEDP and PCWP decreased, but there was no significant difference between the two groups before treatment and in group A; TIMI flow and TIMI flow frame were significantly improved in both groups, the effect of group B was more obvious, both P <0.01.2 There were no deaths during hospitalization and one month after operation, and major adverse cardiac events such as myocardial infarction, revascularization and angina pectoris occurred again. CONCLUSION: An intracoronary combination of anisodamine hydrochloride and tirofiban can significantly reduce the incidence of recurrent AMI without increasing arrhythmia and bleeding complications.