目的 评价冠状动脉内注射替罗非班对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗( PCI)后无复流发生率的影响.方法 将120例STEMI患者分为替罗非班组(替罗非班+直接PCI,60例)和对照组(直接PCI,60例).PCI术中根据TIMI血流分级、TIMI计帧法(cTFC)评价冠状动脉血流.术后24h进行实时心肌声学造影检查,计算心肌灌注缺损计分指数( CSI)及室壁运动计分指数(WMSI).分析术后1h2组患者心电图ST段偏移总和比值(sumSTR)的变化.结果 替罗非班组TIMI3级血流显著多于对照组(P＜0.05),而cTFC显著低于对照组(P＜0.05)；替罗非班组与对照组相比CSI( 1.23±0.33,1.38±0.43,P＜0.05),WMSI(1.52±0.39:1.70±0.38；P＜0.05)均显著降低；与对照组比较,替罗非班组术后1 h sumSTR＞70％比例更高(P＜ 0.05).结论 冠状动脉内注射替罗非班能改善STEMI患者PCI术后心肌血流,防止无复流的发生.%Objective To evaluate the influence of intracoronary tirofiban on the incidence of no reflow after percutaneous coronary intervention ( PCI ) in patients with acute ST segment elevation myocardial infarction ( STEMI ).Methods 120 STEMI patients were divided into tirofiban group ( tirofiban and direct PCI,n =60 ) and control group ( direct PCI,n =60 ).During PCI,coronary flow was evaluated according to TIMI flow grading and corrected TIMI frame count ( cTFC ).The changes in sum ST segment resolution ( sumSTR ) were compared one hour after PCI; myocardial perfusion defect score index ( CSI ) and wall motion score index ( WMSI ) were computed 24 hours after PCI according to myocardial contrast echocardiography ( MCE ).Results The blood flow of TIMI grade 3 was greater in tirofiban group than in the control group ( P ＜ 0.05 ) and cTFC was significantly lower in tirofiban group than in the control group ( P ＜ 0.01 ); CSI and WMSI were was significantly lower in tirofiban group than in the control group ( 1.23 + 0.33 vs.1.38 + 0.43,1.52 + 0.39 vs.1.70 ± 0.38; P＜ 0.05 );,the ratio of sumSTR ＞ 70％ was significantly higher in the tirofiban group than in the control group ( P ＜ 0.05 ).Conclusions Intracoronary tirofiban can improve myocardial blood flow in STEMI patients after PCI and can prevent the occurrence of no reflow.
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