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目的探讨冠脉内联合应用盐酸山莨菪碱和替罗非班对逆转急性心肌梗死(AMI)介入治疗后无再流现象(NRP)的可行性、安全性及临床疗效。方法自2004年3月～2006年8月于我院行冠脉介入治疗的AMI患者252例;男204例,女48例。发生NRP47例,其中男38例,女9例。随机分为替罗非班组和山莨菪碱联合替罗非班组(联合用药组),观察冠脉内有创压、心率、PCWP、LVEDP、TIMI血流及TIMI血流记帧数的变化以及住院期间及术后一个月的主要心脏不良事件发生率。结果冠脉内应用替罗非班对冠脉内有创压、心率、LVEDP及PCWP无明显影响,而联合用药组冠脉内有创压、平均冠脉压、心率明显升高(P<0.05)。LVEDP及PCWP降低但较替罗非班组无显著性差异(P>0.05);两组均明显改善TIMI血流及TIMI血流记帧数,联合用药组效果更明显(均P<0.001)。两组住院期间及术后一个月均无死亡、再次心梗、再次血运重建、心绞痛等主要心脏不良事件发生。结论冠脉内联合应用盐酸山莨菪碱和替罗非班可显著逆转AMI后NRP,不增加恶性心律失常和出血并发症的发生,安全可行,值得临床推广使用。
Objective To investigate the feasibility, safety and clinical efficacy of intracoronary anisodamine and tirofiban in the treatment of non-reflow phenomenon (NRP) after reversal of acute myocardial infarction (AMI). Methods From March 2004 to August 2006 in our hospital coronary intervention in 252 cases of AMI patients; 204 males and 48 females. NRP occurred in 47 cases, including 38 males and 9 females. Randomly divided into tirofiban group and anisodamine combined with tirofiban group (combination group), observed intracoronary pressure, heart rate, PCWP, LVEDP, TIMI blood flow and TIMI changes in the number of frames and hospital stay During and one month after surgery, the incidence of major adverse cardiac events. Results Coronary administration of tirofiban had no significant effect on intracoronary invasive pressure, heart rate, LVEDP and PCWP, while intracoronary invagination, mean coronary pressure, and heart rate in the combination group were significantly increased (P <0.05 ). LVEDP and PCWP were lower than those in the tirofiban group (P> 0.05). TIMI flow and TIMI flow rate were significantly improved in both groups. The effect of combination group was more obvious (both P <0.001). There was no death during the hospitalization and one month after operation in both groups, and again the major cardiac adverse events such as myocardial infarction, revascularization and angina pectoris occurred again. Conclusion An intracoronary combination of anisodamine hydrochloride and tirofiban can significantly reverse NRP after AMI without increasing the occurrence of malignant arrhythmia and bleeding complications, which is safe and feasible and worthy of clinical application.