急诊PCI前冠脉内注射盐酸替罗非班对急性STEMI

患者术中TIMI血流的影响

王智 唐强 唐群中 史振涛 陈学珠 王征

北京大学首钢医院心内科 100041

［摘要］目的：探讨急诊经皮冠状动脉介入治疗(PCI)术前冠脉内注射血小板糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂（盐酸替罗非班）对急性STEMI患者术中TIMI血流的影响。方法：对我院2年来急性ST段抬高型心肌梗死(STEMI)冠脉造影（CAG）显示梗死相关血管(IRA)有血栓征象的患者67例,其中男性48例，女性19例，平均年龄57.4±8.1岁，随机分成试验组（PCI前冠脉内注射盐酸替罗非班＋PCI, n=35）与对照组（直接PCI, n=32）。收集所有病例的临床和 CAG资料，对比2组患者PCI术中IRA TIMI血流情况。结果：试验组PCI术中无复流的发生率明显低于对照组（2.86％对18.75％，P＜0.05），IRA远端栓塞发生率试验组明显低于对照组(0%对15.63％，P＜0.05)。结论：急诊PCI前冠脉内缓慢注射GPIIb/Ⅲa受体拮抗剂盐酸替罗非班可以明显改善急性STEMI患者急诊PCI术中IRA远端的前向血流，降低无复流现象的发生率。

关键词：急性STEMI IRA血栓 急诊PCI 冠脉内 盐酸替罗非班 TIMI血流

TIMI Flow influence of intracoronary Tirofiban injection in patients with STEMI before primary PCI

WANG Zhi , TANG Qiang, TANG Qunzhong , SHI Zhentao，CHEN Xuezhu, WANG Zheng

（Department of Cardiology, Peking University Shougang Hospital, Beijing 100041, China）

ABSTRACT -ive To study TIMI flow influence of GPⅡb/Ⅲa receptor antagonists intracoronary tirofiban injection in patients STEMI before primary PCI. Mathods To select 67 STEMI patients with IRA thrombus during CAG from 2 yeas ago(48man and 19 woman), age 57.4±8.1 years old .divided into two groups, intracoronary tirofiban injection＋PCI group 35 cases,primary PCI group 32 cases .observe two groups TIMI flow during operation. Results slow-flow and no-reflow of intracoronary tirofiban injection＋PCI group was lower than which in primary PCI group（2.86％ vs 18.75％，P＜0.05），embolism of distal IRA was lower than which in primary PCI group during operation(0% vs 15.63％，P＜0.05). Conclusion intracoronary tirofiban injection before primary PCI in patients with STEMI is possible to become effective reperfusion method, the rate of no-reflow is less.

KEY WORDS STEMI IRA thrombus primary PCI intracoronary tirofiban TIMI flow