自制带侧孔灌注球囊对急诊经皮冠状动脉介入治疗术后无复流的治疗作用

摘要

Objective To investigate the therapeutic effect of self made balloon with side hole on no reflow ( NR) after emergency percutaneous coronary intervention ( PCI ) .Methods 48 patients with NR after PCI in our hospital were randomized into two groups , which were group A ( n=24 , patients received self made perfusion balloons with holes ) and group B ( n=24 , patients using direct guiding catheter ) and through respective devices intravascular tirofiban and verapamil were given .TIMI flow grade, recovery of myocardial enzymes and ST-segment elevation , LVEF and the incidence of MACE were compared between the 2 groups.Results Among patients in group A , the percentage of immediate postoperative TIMI Ⅲflow (79.2%vs.45.8%,P=0.032), ST segment resolution of more than 50% (83.3% vs.54.2%,P =0.029 ) and LVEF after 1 months [ ( 54.92 ±12.32 )% vs. ( 47.67 ±12.15 )%, P =0.046 ] were significantly higher than patients in group B .The CK peak value of patients in group A [ ( 1018.62 ± 732.34)mmol/L vs.(1497.75 ±858.63)mmol/L, P =0.043], CK-MB peak values [(113.84 ± 76.53 ) mmol/L vs.( 172.74 ±93.56 ) mmol/L, P=0.021 ] and MACE rates ( 0 vs.16.7%, P=0.037 ) were lower than those of patients in group B .Conclusions The use of self-made perfusion balloon with side hole for the treatment of NR patients after emergency PCI is convenient , easy and effective.%目的：研究自制带侧孔灌注球囊对急诊经皮冠状动脉介入治疗（ PCI ）术后无复流（ NR）的治疗作用。方法纳入首都医科大学附属北京潞河医院经PCI术后发生NR的患者48例，按随机表法分成自制带侧孔灌注球囊组（ A组，24例）和直接经指引导管组（ B组，24例）。观察两组患者TIMI血流分级情况、心肌酶峰值、心电图ST段回落情况、左心室射血分数（ LVEF）及主要不良心血管事件（ MACE）发生率。结果 A组患者术后即刻TIMI Ⅲ级比例（79．2％比45．8％，P＝0．032）、ST段回落＞50％比例（83．3％比54．2％， P ＝0．029）及术后1个月 LVEF [（54．92±12．32）％比（47．67±12．15）％，P＝0．046]均显著高于B组，差异均有统计学意义；而A组患者术后1周内肌酸激酶峰值[（1018．62±732．34） mmol／L比（1497．75±858．63） mmol／L，P＝0．043]、肌酸激酶同工酶峰值[（113．84±76．53）mmol／L比（172．74±93．56） mmol／L，P＝0．021]及术后1个月MACE发生率（0比16．7％，P＝0．037）显著低于B组，差异亦均有统计学意义。结论使用自制带侧孔灌注球囊对急诊PCI术后NR患者进行治疗，具有方便、易操作、安全、有效的优点，具有一定的临床意义，值得推荐。