经改造球囊导管靶血管注射地尔硫卓对急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗术中无复流的影响

发布时间：2018-01-04 12:11

  本文关键词：经改造球囊导管靶血管注射地尔硫卓对急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗术中无复流的影响　出处：《河北医科大学》2014年硕士论文　论文类型：学位论文

  更多相关文章： 直接经皮冠状动脉介入 急性ST段抬高型心肌梗死 冠状动脉无复流 靶血管给药 地尔硫卓

【摘要】：目的：本研究旨在探讨相对于传统经冠状动脉指引导管给药预扩后经改造的预扩球囊靶血管注射地尔硫卓对急性ST段抬高型心肌梗死（STelevation myocardial infarction, STEMI）患者直接经皮冠状动脉介入治疗（primary percutaneous coronary interventions, PPCI）中冠状动脉无复流现象（coronary no reflow phenomenon, CNRP）的影响。 方法：入选2012年7月至2013年12月河北医科大学第三医院心内科收治、明确诊断为STEMI并行PPCI患者随机分为实验组（n=49），对照组（n=51）。PPCI由有10年以上介入经验的心血管内科主任医师按标准操作施行，导丝、导管依解剖结构选择。术前完善心电图、血压测量及其他术前准备，在PPCI中通过冠状动脉造影判明梗死相关动脉（infarctionrelated artery, IRA），继而送入指引导丝，并在对IRA病变处施行球囊预扩张。撤出预扩球囊后，保留指引导丝，实验组以刀片纵向划破使用过的预扩球囊，并经改造的预扩球囊送达IRA病变处注射地尔硫卓稀释液2mg，对照组则在预扩球囊撤出后经指引导管于冠状动脉口处注射等量地尔硫卓稀释液。所有患者均植入药物涂层支架，，术后依据病情由有5年以上工作经验的心血管内科主治及以上医师调整用药，并随访至PPCI术后3个月。观察两组基线资料（包括年龄，性别，平均血压，心率，吸烟史，家族史，既往心绞痛，合并症（高血压病、2型糖尿病、血脂异常），既往心肌梗死（myocardial infarction, MI）、PCI治疗或行冠状动脉旁路移植术（coronary artery bypass grafting, CABG），体重指数，发病时间，就诊-球囊到位（Door-to-balloon, DTB）时间，Killip2级例数，术前用药），冠状动脉造影资料（包括PPCI时间，暴露时间，IRA分布，病变血管支数，支架直径，支架长度，最大扩张压力，扩张次数，指引导丝类型，指引导管类型，初始及支架植入后心肌梗死溶栓试验（thrombolysis inmyocardial infarction, TIMI）血流分级、 TIMI心肌灌注分级（TIMImyocardial perfusion grade, TMPG）），术后心率、平均血压水平，术后2小时有效ST段回落率（即PPCI术后2小时ST段抬高最高导联ST段回落≥50%患者所占比例），术后1周左室射血分数（left ventricle ejectionfraction, LVEF)，术后3个月主要心脏不良事件（major adverse cardiacevents, MACEs），术后用药。CNRP定义为TIMI≤2级。 结果： 1基线资料：两组在年龄，性别，平均血压，心率，吸烟史，家族史，既往心绞痛，合并症（高血压病、2型糖尿病、血脂异常），既往MI、PCI及CABG情况，体重指数，发病时间， DTB时间，Killip2级例数，术前用药无明显统计学差异（P0.05）。 2PCI资料：两组在PPCI时间，暴露时间，IRA分布，病变血管支数，初始TIMI情况，支架长度，支架直径，支架数量，导丝类型，指引导管类型，扩张次数，最大扩张压力，最大扩张压力方面无统计学差异（P0.05），实验组与对照组在支架植入后TMPG（P=0.034），支架植入后TIMI分级（P=0.036）有统计学差异，实验组较对照组最终TMPG、TIMI分级改善，CNRP发生率降低。 3术后资料：实验组较对照组术后平均血压，术后心率，术后3个月MACEs发生率，术后用药无统计学差异（P0.05）;两组在术后2小时有效ST段回落率（30vs.21，P=0.045），术后1周LVEF(52.65±5.36%vs.50.33±4.50%, P=0.021)有统计学差异，实验组较对照组有更高的术后2小时有效ST段回落率和术后1周LVEF水平。 结论：对于STEMI患者行PPCI时，经改造的球囊导管于IRA病变处靶血管注射地尔硫卓较经指引导管冠状动脉内给药能够增加梗死区域冠状动脉血流和微灌注，降低CNRP的发生率，改善患者术后心功能。同时该方法不延长PPCI时间和暴露时间，对血压、心率影响与经指引导给药无差异。
[Abstract]:Objective: This study aimed to investigate the relative to the traditional coronary artery guiding drug pre dilation after transformation of pre expansion balloon target vessel injection of diltiazem on acute ST elevation myocardial infarction (STelevation myocardial, infarction, STEMI) in patients with percutaneous coronary interventional therapy (primary percutaneous coronary interventions, PPCI) in coronary artery of no reflow phenomenon (coronary no reflow phenomenon, CNRP) effect.
Methods: selected from July 2012 to December 2013 admitted to the Department of Cardiology, the Third Hospital of Hebei Medical University, diagnosed as STEMI concurrent PPCI patients were randomly divided into experimental group (n=49), control group (n=51.PPCI) by more than 10 years experience in the cardiovascular physician operating purposes, according to the Standard Guide wire catheter according to the anatomic structure, perfect preoperative choice. The electrocardiogram, blood pressure measurement and other preparation before operation, in PPCI by coronary angiography (infarctionrelated artery, IRA to infarction), and then into the guide wire, and balloon dilation was performed in IRA lesions. The withdrawal of pre expansion balloon, retain the guide wire, the experimental group with longitudinal pre expanded cut blade the balloon used, and by the transformation of the balloon pre dilation delivered to IRA lesions injection of diltiazem diluted 2mg, the control group in the pre expanding balloon withdrawal after guiding catheter in the coronary artery at the mouth of note Shoot with diltiazem dilution. All patients were implanted with drug-eluting stents, cardiovascular medicine attending physicians and above the medication adjustment after surgery according to the disease by more than 5 years work experience, and follow up to 3 months after PPCI. Two groups were observed at baseline (including age, gender, mean blood pressure, heart rate, smoking history, family history, angina pectoris, comorbidities (hypertension, type 2 diabetes, dyslipidemia, previous myocardial infarction (myocardial), infarction, MI, PCI) treatment or coronary artery bypass grafting (coronary artery bypass grafting, CABG), body mass index, onset time, door to balloon in place (Door-to-balloon, DTB Killip2) time, the number of cases, preoperative medication), coronary angiography (including PPCI time, exposure time, IRA distribution, the number of diseased vessels, the diameter of the stent, stent length, maximum expansion pressure, the expansion of the number of guide wire type, refers to The guide tube type, thrombolysis in myocardial infarction and initial stent implantation (thrombolysis inmyocardial infarction, TIMI) flow grade, TIMI myocardial perfusion grade (TIMImyocardial perfusion grade), TMPG), postoperative heart rate, average blood pressure, 2 hours after the operation the effective rate of ST segment resolution (i.e., 2 hours after PPCI ST the highest elevation lead ST segment is more than 50% proportion of patients), 1 weeks after operation, left ventricular ejection fraction (left ventricle ejectionfraction, LVEF), after 3 months of major adverse cardiac events (major adverse, cardiacevents, MACEs), postoperative medication.CNRP defined as TIMI is less than or equal to 2.
Result锛

本文编号：1378437