摘要目的 探讨替罗非班联合血栓抽吸对老年ST段拾高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后心肌再灌注及无复流的影响. 方法 185例STEMI患者随机分为对照组93例和研究组92例.对照组患者行直接支架术,或先行经皮冠脉球囊扩张后,再行支架置入.研究组患者冠状动脉注入替罗非班10 μg/kg,血栓抽吸后进行球囊扩张或直接冠脉内支架置入术.比较两组患者术后恢复情况,记录心脏主要不良事件. 结果 研究组患者术后无复流发生率,平均术前心肌梗死溶栓治疗(TIMI)帧数(CTFC)以及肌酸激酶同工酶(CK-MB)峰值均显著低于对照组[无复流:8例(8.7％)与21例(22.6％),x2=6.752,P＜0.05;CTFC:(26.4±8.7)帧与(34.5±8.2)帧,t=6.517,P＜0.05;CK-MB峰值:(114.5±25.7)U/L与(226.3±27.6)U/L,t=28.506,P＜0.05].研究组患者ST段回落＞50％的比例以及LVEF均高于对照组[ST段回落＞50％:83例(90.2％)与72例(77.4％),x2 =5.581,P＜0.05;左心室射血分数(LVEF):(56.2±8.6)％与(48.8±10.5)％,t=5.241,P＜0.05],研究组患者术后TIMI分级优于对照组(Z=1.984,P＜0.05).治疗期间研究组出现轻度出血19例(20.7％),对照组轻度出血14例(15.1％),两组出血情况无明显差异(x 2=0.990,P=0.320).研究组与对照组住院期间及随访1年的心脏主要不良事件(MACE)事件差异均无统计学意义(x2=2.394,0.452,P＞0.05). 结论 替罗非班联合血栓抽吸能够改善老年STEMI患者PCI术后心肌再灌注水平,具有较高的临床应用价值.

abstractsObjective To investigate the effects of Tirofiban combined with thrombus aspiration on myocardial reperfusion and no-reflow after percutaneous coronary intervention (PCI)in elderly patients with ST-segment elevation myocardial infarction (STEMI).Methods A total of 185 patients with STEMI were randomly divided into a control group(n=93)and a study group(n=92).The control group received direct stenting or percutaneous coronary angioplasty before stent placement.The study group received an intracoronary injection of Tirofiban 10 μg/kg,thrombus aspiration,and then balloon dilatation or direct coronary stenting.Postoperative recovery was compared between the groups,and major adverse cardiovascular events(MACE) were recorded.Results The incidence of no-reflow,the thrombolysis in myocardial infarction,the corrected (TIMI)frame count (CTFC)and the peak of plasma creatine kinase MB isoenzyme(CK MB)were lower in the study group than in the control group[(no reflow,8 cases or 8.7 ％ vs.21cases or 22.6 ％,x2 =6.752,P ＜0.05;CTFC,(26.4±8.7)frame vs.(34.5± 8.2)frame,t =6.517,P＜0.05;CK-MB peak,(114.5±25.7)U/L vs.(226.3 ± 27.6) U/L,t =28.506,P ＜ 0.05].The proportion of patients with descent of ST segment elevation of more than 50％ and the left ventricular ejection fraction(LVEF)were higher in the study group than in the control group[83 cases or 90.2％ vs.72 cases or 77.4％,x2=5.581,P＜0.05;(56.2±8.6) ％ vs.(48.8±10.5)％,t =5.241,P＜0.05].The TIMI grading was better in the study group than in the control group (Z =1.984,P ＜ 0.05).The incidence of mild bleeding during treatment had no significant difference between the study group and the control group(20.7％ or 19 cases vs.15.1％ or 14 cases,x2 =0.99,P =0.32).There was no significant difference in the incidence of MACE events during hospitalization or one-year follow-up between the two groups(x2=2.394,0.452,P ＞ 0.05).Conclusions Tirofiban combined with thrombus aspiration can improve myocardial reperfusion in elderly patients with STEMI after PCI,and has excellent clinical value.