急性心肌梗死患者经靶向灌注导管行梗死相关血管远端逆向用药球囊预扩张对冠状动脉血流的影响

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目的探讨急性ST段抬高心肌梗死患者急诊直接经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)应用靶向灌注导管行梗死相关血管(infarct-related artery,IRA)逆向用药防治冠状动脉慢/无复流研究中小球囊低压力预扩张对其疗效的影响。方法回顾性分析46例急性ST段抬高心肌梗死患者在直接PCI前均应用靶向灌注导管行IRA靶病变远端逆向注射血小板糖蛋白Ⅱb/Ⅲa抑制剂替罗非班、硝酸甘油,根据在IRA逆向用药前靶病变处是否行球囊预扩张分为预扩张组(21例)和未行预扩张组(25例),比较两组的临床资料、术中慢/无复流现象发生率,并观察住院期间主要心血管事件。结果预扩张组患者慢/无复流的发生率9.5%,主要心脏事件发生率9.5%;未行预扩张组患者慢/无复流发生率8%,主要心脏事件发生率12%。结论两组患者慢/无复流和不良心血管事件发生率无明显差别,急性ST段抬高心肌梗死患者经靶向灌注导管行IRA远端逆向用药前IRA靶病变处小球囊低压力预扩张不增加慢/无复流的发生,不影响直接PCI治疗结果。 Objective To investigate the effects of reverse medication on infarct-related artery (IRA) in patients with acute ST-segment elevation myocardial infarction undergoing emergency percutaneous coronary intervention (PCI) The Effect of Low Pressure Premature Dilatation of Small Balloon Vessels on the Curative Effect in Reflux Study. METHODS: Tirofiban and nitroglycerin were retrospectively analyzed in 46 patients with acute ST-segment elevation myocardial infarction who were treated with targeted perfusion catheter and reverse-injected with platelet glycoprotein Ⅱb / Ⅲa. The pre-dilatation of IRA was divided into pre-dilatation group (n = 21) and pre-dilatation group (n = 25). The clinical data of two groups were compared. The incidence of slow / no-reflow , And observed the main cardiovascular events during hospitalization. Results The rate of slow / no-reflow in pre-dilatation group was 9.5%, and the incidence of major cardiac events was 9.5%. The rate of slow / no-reflow in patients without pre-dilation was 8% and the incidence of major cardiac events was 12%. Conclusions There is no significant difference between the two groups in the incidence of slow / no-reflow and adverse cardiovascular events. In patients with acute ST-segment elevation myocardial infarction, the low pressure preconditioning Expansion does not increase the occurrence of slow / no reflow, does not affect the results of direct PCI.
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