杨乐,
张志^,,
初巍巍,
刘熠,
孙笑林,
李一代,
唐兆杰,
于震,
张兴
大连市第三人民医院 心内科, 辽宁 大连 116033

基金项目: 大连市医学科学研究计划(1711046)


详细信息 作者简介: 杨乐(1992-), 男, 主治医师。E-mail:1136262259@qq.com









通讯作者: 张志, 主任医师。E-mail:ningcheng631@163.com 中图分类号: R737.33


摘要:目的探究血栓抽吸联合替罗非班及硝普钠对急性ST段抬高型心肌梗死(STEMI)患者球囊后扩张相关性无复流的预防效果。方法收集发病12 h内急诊行经皮冠状动脉介入术(percutaneous coronary intervention，PCI)，并进行球囊后扩张的STEMI患者254例，根据是否进行球囊后扩张相关性无复流的预防分为常规后扩张组和优化后扩张组[147例，男117例，女30例，平均年龄(63.39±13.84)岁]和优化后扩张组[107例，男86例，女21例，平均年龄(63.11±11.34)岁]，优化后扩张组依据TIMI血栓积分结果进行血栓抽吸及预防性用药。比较两组临床资料、造影特征、介入治疗后疗效及术后1年主要心血管不良事件的差异。结果常规后扩张组与优化后扩张组基本临床资料及造影特征差异无统计学意义。优化后扩张组球囊后扩张相关性无复流发生率(2.80%)低于常规后扩张组(10.88%)，差异具有统计学意义(P=0.016)。优化后扩张组2 h内ST段回落≥ 50%的比例(87.85%)高于常规后扩张组(77.55%)，差异具有统计学意义(P=0.047)。两组间术后24 h内心绞痛比例、CK-MB峰值及心功能指标(LVEF、LVEDD)差异均无统计学意义。优化后扩张组术后1年因心衰再住院的比例(0.93%)低于常规后扩张组(6.12%)，两组间差异有统计学意义(P=0.048)。术后1年其他MACE事件(IRA导致的再发心绞痛、IRA再次血运重建、心源性死亡)发生比例及心功能指标(LVEF、LVEDD)两组间差异均无统计学意义。结论STEMI患者预防性应用血栓抽吸联合替罗非班及硝普钠，有助于降低球囊后扩张相关性无复流的发生，有效提高PCI术后疗效，减少心血管不良事件发生。
关键词: 急性ST段抬高型心肌梗死/
球囊后扩张/
无复流


Abstract:ObjectiveTo investigate the preventive effect of thrombus aspiration combined with tirofiban and sodium nitroprusside on coronary no-reflow after balloon dilatation in patients with acute ST-segment elevation myocardial infarction (STEMI).MethodsA total of 254 patients with STEMI who received emergency percutaneous coronary intervention (PCI) and underwent post-stenting balloon dilation (PSBD) within 12 hours were collected and divided into routine PSBD groups [147 patients, 117 males and 30 females, average age (63.39±13.84) years-old] and optimized PSBD group [107 patients, 86 males and 21 females, average age (63.11±11.34) years-old]. Patients in the optimized PSBD group received thrombus aspiration and preventive medication based on the results of TIMI thrombus score. The clinical data, angiographic characteristics, efficacy after interventional therapy, and major cardiovascular adverse events after 1 year were analyzed and compared between the two groups.ResultsThere were no significant differences in basic clinical data and angiographic features between the routine PSBD group and the optimized PSBD group. The incidence of no-reflow associated with balloon dilatation in the optimized PSBD group (2.80%) was lower than that in the routine PSBD group (10.88%), and the difference was statistically significant (P=0.016). The proportion of ST segment fallback over 50% within 2 hours in the optimized PSBD group (87.85%) was higher than that in the routine PSBD group (77.55%), and the difference was statistically significant (P=0.047). There were no significant differences in angina pectoris ratio, peak CK-MB, and cardiac function indicators (LVEF, LVEDD) within 24 hours after operation between the two groups. The proportion of rehospitalization due to heart failure (0.93%) in the optimized PSBD group was lower than that in the routine PSBD group (6.12%) after one year, and the difference between the two groups was statistically significant (P=0.048). There was no significant difference in the proportion of other MACE events (recurrent angina pectoris caused by IRA, revascularization of IRA, cardiogenic death) and cardiac function indicators (LVEF, LVEDD) at one year after operation.ConclusionsThe prophylactic use of thrombus aspiration combined with tirofiban and sodium nitroprusside in STEMI patients can help reduce the incidence of no-reflow associated with balloon dilatation, effectively improve the efficacy after PCI, and reduce cardiovascular adverse events.
Keywords:ST elevation myocardial infarction/
post-stenting balloon dilation (PSBD)/
no-reflow phenomenon

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