提前肝素化和超选择冠状动脉内注入替罗非班对STEMI患者PCI的影响
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摘要
目的评价提前肝素化和超选择冠状动脉内注入替罗非班对急性ST段抬高心肌梗死(STEMI)患者经皮冠脉介入术(PCI)的影响。方法选取2016年1月—2018年12月中山大学附属第三医院粤东医院STEMI患者行急诊PCI共120例,随机将其分为对照组和观察组各60例。对照组采用常规PCI程序,观察组采用提前肝素化、直接用指引导管造影和超选择冠状动脉内注入替罗非班。比较两组靶血管TIMI血流3级的校正帧数,术后90 min的心电图ST段回落率,入院后30 min、6、12、24、36和48 h的心肌型酸酶同工酶(CK-MB)和血清心肌肌钙蛋白I(cTn I)值和到达峰值时间,住院期间主要心脏不良事件(MACE)和严重出血事件。结果观察组与对照组比较,TIMI校正帧数减小,ST段回落率增加,CK-MB和c Tn I的峰值降低,峰值时间提前,MACE发生率降低,差异有统计学意义(P <0.05)。两组严重出血事件比较差异无统计学意义(P>0.05)。结论提前肝素化和超选择冠状动脉内注入替罗非班对STEMI患者急诊PCI可缩短缺血心肌再灌注时间,增加心肌存活,改善近期预后。
Objective To study effect of early heparinize and intracoronary infusion of Tirofiban on PCI treatment in patients with acute ST segment elevated myocardial infarction(STEMI). Methods A total of 120 cases with acute STEMI received PCI in the Third Affiliated Hospital of Sun Yat-Sen University-Yuedong Hospital during January 2016 to December 2018. Patients were enrolled in this study and were divided randomly into control group and observation group(n = 60). Patients in control group received routine PCI procedure. Patients in observation group received early heparinize and intracoronary infusion of tirofiban. Corrected frames to TIMI blood flow of level 3 in target vessel, ST segment recovery rate in electrocardiogram after operation 90-min, peak value and time of CK-MB and cTnI at various timepoint(30 min, 6 h, 12 h, 24 h, 36 h and 48 h), major adverse cardiac events were recorded. Results Patients in observation group experienced significant decrease in the TIMI corrected frames, peak value and time of CK-M and cTnI(P < 0.05) while ST segment recovery rate was increased obviously compared with those in control group(P < 0.05). No obvious difference in severe bleeding events rate was identified in the two groups(P > 0.05). Conclusions Early heparinize and intracoronary infusion of Tirofiban shorten reperfusion time of ischemic myocardium, improving outcome of patients with acute STEMI.
Objective To study effect of early heparinize and intracoronary infusion of Tirofiban on PCI treatment in patients with acute ST segment elevated myocardial infarction(STEMI). Methods A total of 120 cases with acute STEMI received PCI in the Third Affiliated Hospital of Sun Yat-Sen University-Yuedong Hospital during January 2016 to December 2018. Patients were enrolled in this study and were divided randomly into control group and observation group(n = 60). Patients in control group received routine PCI procedure. Patients in observation group received early heparinize and intracoronary infusion of tirofiban. Corrected frames to TIMI blood flow of level 3 in target vessel, ST segment recovery rate in electrocardiogram after operation 90-min, peak value and time of CK-MB and cTnI at various timepoint(30 min, 6 h, 12 h, 24 h, 36 h and 48 h), major adverse cardiac events were recorded. Results Patients in observation group experienced significant decrease in the TIMI corrected frames, peak value and time of CK-M and cTnI(P < 0.05) while ST segment recovery rate was increased obviously compared with those in control group(P < 0.05). No obvious difference in severe bleeding events rate was identified in the two groups(P > 0.05). Conclusions Early heparinize and intracoronary infusion of Tirofiban shorten reperfusion time of ischemic myocardium, improving outcome of patients with acute STEMI.
引文
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[7]张源波,苏锡明,林月,等.D-二聚体在急性心肌梗死时冠状动脉血栓自溶再通的演变及意义[J].中华老年心脑血管病杂志,2014,16(9):938-941.
[8]沈剑耀,王超权,王黎,等.急诊经皮IL指引导管直接PCI与常规造影后更换指引导管行PCI治疗的对比研究[J].心电与循环,2017,36(2):81-84.
[9]郭金成,王国忠,朱芙丽,等.经桡动脉应用MAC指引导管行急诊冠状动脉造影和介入治疗的可行性[J].首都医科大学学报,2015,36(1):78-83.
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[11]ROBERTS E B,WOOD A.Use of a single Q guide catheter for complete assessment and treatment of both coronary arteries via radial access during acute st elevation myocardial infarction:a review of 40 consecutive cases[J].Interv Cardiol,2011,24(5):389-396.
[12]唐良秋,张晓静,陈云宪,等.超选择冠脉内注射替罗非班联合血栓抽吸对急性ST段抬高型心肌梗死患者心肌灌注的影响[J].中国心血管病研究,2015,13(12):1123-1126.
[13]夏菲,王曼萍,张林,等.冠脉注射替罗非班对ST段抬高型心肌梗死患者再灌注疗效研究[J].中南药学,2015,13(12):1331-1335.
[14]CHEN Y,ZHOU P,YAH H,et a1.Impact of selective infarctrelated artery infusion of tirofiban on myocardial reperfusion and bleeding complications in patients with acute myocardial infarction:the SUIT-AMI trial[J].Invasive Cardiol,2013,25(4):376-382.
[15]KOUZ R,KOUZ S,SCHAMPAERT E,et al.Effectiveness and safety of glycoprotein IIb/IIIa inhibitors in patients with myocardial infarction undergoing primary percutaneous coronary intervention:a meta-analysis of observational studies[J].Int JCardiol,2011,153(3):249-255.
[16]张在勇,张稳柱,宋明才,等.血栓抽吸结合血栓部位注射替罗非班在急诊PCI中的应用[J].临床心血管病杂志,2014,30(5):384-387.
[17]娄唯鸣.血栓抽吸前替罗非班冠状动脉内注射在急性ST段抬高型心肌梗死患者中的应用[J].郑州大学学报(医学版),2012,47(6):870-873.
[18]CANDEMIR B,KILICKAP M,OZCAN O U,et al.Intracoronary versus intravenous high-dose bolus plus maintenance administration of tirofi ban in patients undergoing primary percutaneous coronary intervention for acute ST elevation myocardial infarction[J].Thromb Thrombolysis,2012,34(1):65-72.
[2]O’GARA P T,KUSHNER F G,ASCHEIM D D,et al.2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarc-tion:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].J Am Coll Cardiol,2013,61(4):e78-e140.
[3]YAN H B,LI S Y,SONG L,et a1.Thrombus aspiration plus intrainfarct-related artery administration of tirofiban improves myocardial perfusion during primary angioplasty for acute myocardial infarctio[J].Chin Med J(Engl),2010,123(8):877-883.
[4]de LUCA G,VERDOIA M,SURYAPRANATA H.Benefits from intracoronary as compared to intravenous abciximab administration for STEMI patients undergoing primary angioplasty:a meta analysis of 8 randomized trials[J].Atherosclerosis,2012,222(15):426-433.
[5]占德进,朱绍亨,罗瑞英,等.急性ST段抬高型心肌梗死急诊PCI前应用普通肝素对梗死相关动脉发生自溶现象的影响观察[J].实用中西医结合临床,2015,15(7):15-16.
[6]董淑娟,楚英杰,余海佳,等.替罗非班对急性心肌梗死早期自溶的影响[J].实用医学杂志,2017,19(33):3330-3331.
[7]张源波,苏锡明,林月,等.D-二聚体在急性心肌梗死时冠状动脉血栓自溶再通的演变及意义[J].中华老年心脑血管病杂志,2014,16(9):938-941.
[8]沈剑耀,王超权,王黎,等.急诊经皮IL指引导管直接PCI与常规造影后更换指引导管行PCI治疗的对比研究[J].心电与循环,2017,36(2):81-84.
[9]郭金成,王国忠,朱芙丽,等.经桡动脉应用MAC指引导管行急诊冠状动脉造影和介入治疗的可行性[J].首都医科大学学报,2015,36(1):78-83.
[10]CHOW J,TAN C H,TIN A S,et al.Feasibility of transradial coronary angiography and intervention using a single Ikari left guiding catheter for ST elevation myocardial infarction[J].Interv Cardiol,2012,25(3):235-244.
[11]ROBERTS E B,WOOD A.Use of a single Q guide catheter for complete assessment and treatment of both coronary arteries via radial access during acute st elevation myocardial infarction:a review of 40 consecutive cases[J].Interv Cardiol,2011,24(5):389-396.
[12]唐良秋,张晓静,陈云宪,等.超选择冠脉内注射替罗非班联合血栓抽吸对急性ST段抬高型心肌梗死患者心肌灌注的影响[J].中国心血管病研究,2015,13(12):1123-1126.
[13]夏菲,王曼萍,张林,等.冠脉注射替罗非班对ST段抬高型心肌梗死患者再灌注疗效研究[J].中南药学,2015,13(12):1331-1335.
[14]CHEN Y,ZHOU P,YAH H,et a1.Impact of selective infarctrelated artery infusion of tirofiban on myocardial reperfusion and bleeding complications in patients with acute myocardial infarction:the SUIT-AMI trial[J].Invasive Cardiol,2013,25(4):376-382.
[15]KOUZ R,KOUZ S,SCHAMPAERT E,et al.Effectiveness and safety of glycoprotein IIb/IIIa inhibitors in patients with myocardial infarction undergoing primary percutaneous coronary intervention:a meta-analysis of observational studies[J].Int JCardiol,2011,153(3):249-255.
[16]张在勇,张稳柱,宋明才,等.血栓抽吸结合血栓部位注射替罗非班在急诊PCI中的应用[J].临床心血管病杂志,2014,30(5):384-387.
[17]娄唯鸣.血栓抽吸前替罗非班冠状动脉内注射在急性ST段抬高型心肌梗死患者中的应用[J].郑州大学学报(医学版),2012,47(6):870-873.
[18]CANDEMIR B,KILICKAP M,OZCAN O U,et al.Intracoronary versus intravenous high-dose bolus plus maintenance administration of tirofi ban in patients undergoing primary percutaneous coronary intervention for acute ST elevation myocardial infarction[J].Thromb Thrombolysis,2012,34(1):65-72.