冠状动脉内注射血塞通对ST段抬高型急性心肌梗死介入术中缓再流现象的影响

Effect of Intracoronary Injection with Xuesaitong in Treating Post-PCI Slow-reflow Phenomenon in Patients with ST-Segment Elevation Myocardial Infarction

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DOI：

中文关键词: 缓再流冠状动脉血塞通替罗非班

英文关键词:slow-reflow coronary artery Xuesaitong tirofiban

基金项目:

作者	单位
甘立军	济宁医学院附属医院心内科华中科技大学同济医学院附属协和医院心内科
张春卉	济宁医学院附属医院心内科
张猛	济宁医学院附属医院心内科
程云涛	济宁医学院附属医院心内科
廖玉华	华中科技大学同济医学院附属协和医院心内科

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中文摘要:

目的对照观察冠状动脉内注射血塞通(三七总皂甙)对ST段抬高型急性心肌梗死(STEMI)介入术中缓再流现象的疗效、不良反应及对患者预后的影响。方法选取39例接受经皮冠状动脉腔内成形术和支架术(PTCA/STENT)后发生缓再流现象的STEMI患者,随机分为血塞通+替罗非班组(20例)和替罗非班组(19例)。血塞通+替罗非班组在发生缓再流现象的病变血管内注射替罗非班10 mL(0.5 mg)+血塞通400 mg,然后替罗非班10 mL/h持续静脉滴注36 h,0.9%氯化钠250 mL+血塞通400 mg,静脉滴注,每天1次,用药2天;替罗非班组在病变血管内注射替罗非班0.5 mg后,继续给予替罗非班10 mL/h持续静脉滴注36 h。注射1、5、10 min后重复冠状动脉造影,记录注药前后病变血管内心肌梗死溶栓试验(thrombolysisin myocardial infarction,TIMI)血流分级,并应用TIMI血流计帧法(TIMI frame count,TFC)定量测定血流速度;详细记录注药后2 h内ST段回落幅度,48 h内各种出血发生率,随访6个月,观察两组患者心血管事件发生率。结果注药前血塞通+替罗非班组和替罗非班组TIMI血流分级、TFC两组比较,差异无统计学意义(P>0.05)。血塞通+替罗非班组在冠脉内注药后有11例(55%)患者获得TIMI 3级血流,注药后1、5、10 min时TFC分别为57.6±12.6、46.1±9.3、49.8±10.9,注药后2 h ST段回落幅度为(1.85±0.31)mm;替罗非班组注药后有8例(42%)患者获得TIMI 3级血流,注药后1、5、10 min时TFC分别为69.3±16.1,61.2±15.3,63.7±18.3,注药后2 h ST段回落幅度为(1.40±0.21)mm。两组冠状动脉内注药后血流均有明显改善(P<0.05),血塞通+替罗非班组血流改善较替罗非班组更为显著(P<0.05),2 h内ST段回落幅度两组比较,差异亦有统计学意义(P<0.05)。住院期间两组均无患者死亡,随访6个月,两组心血管事件(心绞痛、心肌梗死、心衰、心因性死亡)发生率分别为33%(6/18)和44%(8/18),差异无统计学意义。结论冠脉内注射血塞通+替罗非班较单用替罗非班能更有效地改善冠状动脉血流,并不明显增加出血并发症发生率。

英文摘要:

Objective To evaluate the effect and safety of Xuesaitong(XST,a Panax Notonginseng extract preparation) via intracoronary injection for treating post-PCI slow-reflow phenomenon in patients with ST-segment elevation myocardial infarction(STEMI) and its impact on patients′ prognosis.Methods Thirty-nine STEMI patients who suffered from post-PCI slow-reflow after received percutaneous transluminal coronary angioplasty or stenting were assigned to two groups,20 patients in the treated group and 19 in the control group.Intra-coronary administering of 10 mL(0.5 mg) tirofiban and 400 mg XST were given to the treated group through guiding catheter,and followed with 36 h continuous intravenous dripping of tirofiban 10 mL/h and 400 mg XST in 250 mL of saline for dripping,while to the control group,the same intracoronary administering and intravenous dripping of tirofiban but without XST was given.The treatment was implemented for two days.Patients′ coronary flow was assessed by the TIMI frame count method(TFC) at 1 min,5 min and 10 min after injection;and the changes of ST-segment in 2 h,and incidence of bleeding in 48 h after medication were recorded.All patients were followed-up for 6 months to observe the incidence of cardiovascular events.Results Before the medication,the TIMI flow grade and the TFC in the treated group and the control group showed insignificantly statistical difference between groups(P>0.05).After medication,11 patients(55%) in the treated group and 8 patients(42%) in the control group with their blood flow reaching TIMI grade 3;the TFC decreased at 1,5 and 10 min to 57.6±12.6,46.1±9.3,49.8±10.9 in the treated group and to 69.3±16.1,61.2±15.3,63.7±18.3 in the control group;and the 2 h ST segment fallback in them was 1.85±0.31 mm and 1.40±0.21 mm respectively,showing that the coronary blood flow in both groups were improved significantly after medication but the improvement in the former was better than in the latter group(P<0.05).No case of death occurred in the hospitalization period.Results of 6-month follow-up study showed that the incidence of major adverse cardiac events,including angina pectoris,myocardial infarction,heart failure and cardiac death,was 33% in treated group and 44%in the control group,showing insignificant difference between groups(P>0.05).Conclusion Concomitant coronary injection with tirofiban and XST is more effective than that with tirofiban alone in improving the coronary blood flow and shows no increasing on the incidence of hemorrhagic complication.

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