替格瑞洛联合冠状动脉内注射替罗非班对STEMI急诊PCI后心肌灌注和预后的影响

摘要

目的 探讨替格瑞洛联合冠状动脉内注射替罗非班对急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入治疗(PCI)后心肌灌注和临床预后的影响.方法 STEMI急诊PCI患者108例随机均分为两组:替格瑞洛组(术前口服替格瑞洛180mg和阿司匹林300mg+冠状动脉内注射替罗非班10μg/kg);氯吡格雷组(术前口服氯吡格雷600mg和阿司匹林300mg+冠状动脉内注射替罗非班10μg/kg).比较两组PCI术后梗死相关动脉心肌梗死溶栓试验(TIMI)血流分级、校正的TIMI血流帧数(CTFC)及梗死相关血管支配的心肌组织TIMI心肌灌注分级(TMP)、PCI术后7d心功能及PCI术后6个月内主要不良心脏事件(MACE)及出血并发症.结果 替格瑞洛组急诊PCI后梗死相关血管TIMI血流3级比例、心肌组织TMP 3级比例和术后7d左心室射血分数均高于氯吡格雷组(P<0.05),CTFC、慢血流或无复流比例、术后7d左心室舒张末期内径和左心室收缩末期内径低于氯吡格雷组(P<0.05).氯吡格雷组6个月内总MACE发生率高于替格瑞洛组(18.52% vs.3.70%)(P<0.05).结论 对于STEMI行急诊PCI患者,替格瑞洛联合冠状动脉内注射替罗非班使用安全、有效,可降低6个月内MACE发生率,改善预后.%Objective To explore the effects of ticagrelor combined with intracoronary injection of tirofiban on myocardial perfusion and clinical prognosis after emergency percutaneous coronary intervention(PCI) in the patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 108 patients with STEMI was randomized into groups of A(treated with ticagrelor 180mg combined with aspirin 300mg before emergency PCI plus intravenous injection of tirofiban 10μg/kg) and B(given clopidogrel 600mg combined with aspirin 300mg before emergency PCI plus intravenous injection of tirofiban 10μg/kg).The post-PCI myocardial infarction thrombolysis(TIMI) blood flow classification and corrected TIMI frame counts(CTFC) in the infarct-related artery,TIMI myocardial perfusion(TMP) grades of myocardial tissues supplied by the infarct-related artery,cardiac function on the 7th day after PCI,major adverse cardiac events(MACE) within 6 months of PCI and hemorrhage complications were compared between the two groups.Results The percentages of TIMI blood flow grade 3 and TMP grade 3 in myocardial tissues and the left ventricular ejection fraction were higher,the CTFC,slow flow or no-reflow ratio,left ventricular end-diastolic diameter and left ventricular end-systolic diameter on the 7th day after operation were lower in group A than those in group B(P<0.05).The incidence of total MACE events in group B was higher than that in group A(18.52% vs.3.70%)(P<0.05).Conclusion For STEMI patients undergoing emergency PCI,trogradil combined with intracoronary injection of tirofiban is safe and effective,which can reduce the incidence of MACE within 6 months and improve the prognosis.