依替巴肽冠状动脉内给药治疗ST段抬高型心肌梗死的疗效评价

摘要

Objective To evaluate the efficacy and safety of intracoronary eptifibatide only during primary percutaneous coronary intervention ( PCI ) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods The 52 STEMI patients were randomly divided into two groups according their random number created by computer:the intracoronary group (n=26) and the intravenous group (n=26). Postoperative TIMI flow grade (TFG),corrected TIMI flow frames (cTFC),90 min postoperative ST segment resolution ( STR ) , postoperative cardiac function parameters, and any bleeding events during hospitalization and after 30 day major adverse cardiac events ( MACE ) were recorded and analyzed after completion of primary PCI. Results There was no significant difference between the two groups with regard to the TFG (χ2 =2. 44,P =0. 313),MACE (3. 8% vs. 0,χ2 =0. 00,P =1. 000),left ventricular ejection fraction (58. 54% ± 4. 56% vs. 56. 62% ± 6. 69%,t =1. 211,P =0. 232),left ventricular end-diastolic dimension [(49. 96 ± 4. 85) mm vs. (51. 42 ± 6. 35) mm,t=0. 962,P=0. 351] and regional wall motion abnormality (80. 77%vs. 73. 08%,χ2 =0. 435,P =0. 510). Compared with intravenous group,the ratio of complete STR in intracoronary group was significantly higher (88. 46%vs. 61. 54%,χ2 =5. 24,P=0. 025) and the cTFC was shorter (16. 44 ± 4. 61 vs. 18. 30 ± 5. 61,t=2. 30,P=0. 028). The bleeding rate was not statistically significant between the two groups (3. 85% vs. 11. 54%,χ2 =1. 063,P =0. 303). Conclusions The intracoronary eptifibatide only strategy, which may improve microvascular perfusion demonstrated by an improved STR and cTFC, is an alternative regimen for patients with acute STEMI undergoing primary PCI.%目的：比较直接经皮冠状动脉介入术（ PCI）治疗急性ST段抬高型心肌梗死（ STEMI）时冠状动脉内或外周静脉内给予依替巴肽的临床疗效和安全性。方法计算机生成随机数后将52例STEMI患者分为两组：冠状动脉负荷组（冠状动脉组，n＝26）和静脉治疗组（静脉组，n＝26）。记录并分析患者术后TIMI血流分级（ TFG）及修正的TIMI血流帧数（ cTFC），术后90 min心电图ST段回落（ STR），术后心脏功能参数，住院期间发生的任何出血事件及术后30 d 主要不良心脏事件（MACE）。结果两组间TFG（χ2＝2.44，P＝0.313）、MACE（3.8％比0，χ2＝0.00，P＝1.000）、左心室射血分数（58.54％±4.56％比56.62％±6.69％， t ＝1.211， P ＝0.232）、左心室舒张末期内径[（49.96±4.85）mm比（51.42±6.35） mm，t ＝0.962，P ＝0.351]及室壁运动异常（80.77％比73.08％，χ2＝0.435，P＝0.510）比较差异均无统计学意义。冠状动脉组完全STR回落比例显著高于静脉组（88.46％比61.54％，χ2＝5.24，P ＝0.025）。冠状动脉组 cTFC 帧数也明显少于静脉组（16.44±4.61比18.30±5.61，t＝2.30，P＝0.028）。两者间出血事件差异无统计学意义（3.85％比11.54％，χ2＝1.063，P＝0.303）。结论对于急性STEMI行直接PCI术的患者，仅冠状动脉内负荷依替巴肽治疗方案可以改善术后心肌再灌注水平，是临床实践中可供选择的治疗方法。