摘要
目的:观察经血栓抽吸导管冠脉内注射尼可地尔对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后慢血流/无复流(thrombolysis in myocardial infarction,TIMI)的疗效。方法:采用单中心随机对照研究,将新乡市中心医院行急诊PCI的高血栓负荷STEMI患者常规进行血栓抽吸和替罗非班应用,随机数字表法分为尼可地尔组和对照组,尼可地尔组经血栓抽吸导管注射尼可地尔,对照组给予生理盐水,观察术后肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)峰浓度、达峰时间、TIMI血流分级、校正TIMI血流帧数、TIMI心肌灌注分级、术后90 min ST段回落率(ST-segment revolution,STR)、症状性低血压和症状性心动过缓的发生率。出院后1个月随访主要不良心血管事件(major adverse cardiovascular events,MACEs)。结果:尼可地尔组TIMI心肌灌注分级3级比例、STR比例均高于对照组(P<0.05)。慢血流/无复流(TIMI≤2级)的发生率、校正TIMI血流帧数、CK-MB峰值浓度、达峰时间均低于对照组(P<0.05)。尼可地尔组MACEs发生率低于对照组(P<0.05)。2组患者术中症状性低血压和心动过缓发生率无明显差异(P>0.05)。结论:对高血栓负荷的STEMI患者经血栓抽吸导管冠脉内注射尼可地尔能更好地改善组织水平灌注,降低术后MACEs发生率,对血流动力学无明显影响。
Objective:To investigate therapeutic efficacy of intracoronary nicorandil injection through thrombus aspiration on slow/noreflow during primary percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods:This was a single-center prospective randomized trial.Consecutive 100 STEMI patients with high thrombus load underwent thrombus aspiration were randomly divided into nicorandil group and control group,followed by administration of nicorandil4 mg or saline distal to the target lesion via thrombus aspiration.Peak level of creatine kinase isoenzyme(CK-MB),peak time,TIMI blood flow grading,corrected TIMI frame count(c TFC),TIMI myocardial perfusion grading(TMPG),and ST-segment resolution(STR)90 min after PCI and hemodynamics parameters were recorded.Major adverse cardiovascular events(MACEs)were obtained at 1-month follow-up.Results:The proportion of TMPG3,STR in nicorandil group were statistically higher than those in control group(all P<0.05).The incidence of slow blood flow/no-reflow(TIMI≤grade 2),cTFC,peak level of CK-MB,peak time in nicorandil group were significantly lower than those in control group(all P<0.05).The incidence of MACEs in nicorandil group was lower than that in the control group(P<0.05).There was no significant difference in the incidence of symptomatic hypotension and symptomatic bradycardia between the two groups(P>0.05).Conclusion:Intracoronary administration of nicorandil through thrombus aspiration catheter in STEMI patients with high thrombus load can better improve myocardial tissue perfusion and reduce the incidence of MACEs,with no significant effect on hemodynamics.
作者
杨树涵
陈红伟
刘艳宾
王志方
邢永生
Yang Shuhan;Chen Hongwei;Liu Yanbin;Wang Zhifang;Xing Yongsheng(Department of Cardiology,Xinxiang Central Hospital)
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2021年第2期176-179,共4页
Journal of Chongqing Medical University
