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目的探讨冠状动脉内注射血小板Ⅱb/Ⅲa受体拮抗剂对ST段抬高型急性心肌梗死(AMI)急诊经皮冠状动脉介入治疗(PCI)中无复流TIMI血流的影响。方法选择AMI后PCI患者420例,研究组为术中出现无复流或慢复流患者32例,对照组为术中未出现无复流患者388例。术中出现无复流或慢复流时,先给予硝酸甘油冠状动脉内注射,对无效者再冠状动脉内注射替罗非班,术后替罗非班静脉维持,术中2组患者肝素用量8 000～10 000 U。结果研究组梗死相关动脉(IRA)PCI术后TIMI血流Ⅲ级95.4%,与对照组TIMI血流Ⅲ级94.6%比较差异无统计学意义(P>0.05)。研究组PCI术后ST段完全回落率高于对照组(P<0.05)。2组发病后第1周cTnI、CK-MB峰值水平及平均水平比较差异无统计学意义(P>0.05)。2组术后均无心血管事件发生,研究组发生尿潜血阳性4例,经减用肝素后好转。结论冠状动脉内注射血小板Ⅱb/Ⅲa受体拮抗剂治疗AMI急诊PCI术中无复流安全有效。
Objective To investigate the effect of intracoronary injection of platelet Ⅱ b / Ⅲ a receptor antagonist on no-reflow TIMI flow in patients with ST-segment elevation acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). METHODS: A total of 420 PCI patients undergoing AMI were selected. The study group included 32 patients with no-reflow or slow-reflow during operation and 388 patients without recurrence during operation. Intraoperative non-reflow or slow reflow, the first given intramuscular injection of nitroglycerin, and then intracoronary injection of tirofiban ineffective, postoperative tirofiban vein maintenance, intraoperative two groups of patients with heparin dose 8 000 ~ 10,000 U. Results Infarct-related artery (IRA) grade III TIMI grade 95.4% in PCI group was not significantly different from that in TIMI III grade 94.6% group (P> 0.05). The complete recovery rate of ST segment after PCI in study group was higher than that in control group (P <0.05). There was no significant difference in peak and average levels of cTnI and CK-MB between the two groups at the first week after onset (P> 0.05). No postoperative cardiovascular events occurred in both groups. Urinary occult blood was found in 4 patients in the study group, which was improved after reduction of heparin. Conclusion Intracoronary injection of platelet Ⅱ b / Ⅲ a receptor antagonist is safe and effective in the treatment of AMI without recurrence during PCI.