冠状动脉内应用依替巴肽对急性心肌梗死患者冠状动脉无复流和心肌灌注的影响

发布时间：2018-03-11 05:20

本文选题：依替巴肽　切入点：心肌梗死　出处：《中国循环杂志》2016年09期 　论文类型：期刊论文

【摘要】：目的:评价冠状动脉内应用依替巴肽对急性心肌梗死(AMI)患者冠状动脉无复流和心肌灌注的影响。方法:急诊经皮冠状动脉介入治疗(PCI)的ST段抬高型AMI(STAMI)患者80例,随机分为依替巴肽组40例和对照组40例。比较两组患者的基线资料,PCI术后血管再通情况及用药前后血小板聚集率变化。手术后即刻及24周时查超声心动图;术后1周查心肌灌注显像。随访24周,观察主要不良心血管事件(MACE)发生率。结果 :与对照组比,依替巴肽组在PCI术后心肌梗死溶栓治疗临床试验(TIMI)血流3级比例(72.5%vs 92.5%)及TIMI心肌灌注3级比例(70.0%vs 90.0%)均显著升高(P均0.05)。依替巴肽组术后及停药后2 h血小板聚集率均较术前有显著性降低,且较对照组同时段降低,差异均有统计学意义(P均0.05)。依替巴肽组术后24周左心室舒张末直径及左心室射血分数较术后1周有显著性改善,且均优于对照组(P均0.05)。依替巴肽组用药期间发生小出血事件7例(17.5%),对照组发生小出血事件3例(7.5%),两组比较差异无统计学意义(P0.05)。两组患者均无大出血事件发生,住院期间均无血小板减少事件发生。两组24周随访MACE发生率(12.5%vs 22.5%)比较,差异无统计学意义(P0.05)。结论:在STAMI患者行急诊PCI时,冠状动脉内应用依替巴肽可有效改善冠状动脉血流,增加心肌灌注,明显改善患者心功能。冠状动脉内应用依替巴肽不增加大出血风险,并且随访24周,不增加MACE发生率。
[Abstract]:Objective: to evaluate the effect of intracoronary etibatin on coronary artery no-reflow and myocardial perfusion in patients with acute myocardial infarction (AMI). Methods: 80 patients with ST-segment elevation AMI (St segment elevation AMI) undergoing emergency percutaneous coronary intervention (PCI) were enrolled in this study. The patients were randomly divided into two groups: Etibatin group (n = 40) and control group (n = 40). The baseline data of the two groups were compared, and the blood vessel recanalization and platelet aggregation rate before and after PCI were compared. Echocardiography was performed immediately after operation and 24 weeks after PCI. Myocardial perfusion imaging was performed 1 week after operation. 24 weeks follow-up was followed to observe the incidence of major adverse cardiovascular events (MACEE). Results: compared with the control group, Clinical trial of thrombolytic therapy in patients with myocardial infarction after PCI. It was significantly lower than that before operation. The mean left ventricular end-diastolic diameter and left ventricular ejection fraction at 24 weeks after operation were significantly improved in Etibatin group compared with those in control group at the same time, and the difference was statistically significant (P < 0.05). It was better than the control group (P < 0.05). There were 7 cases of small hemorrhage in Etibatin group and 3 cases of small hemorrhage event in control group (P < 0.05). There was no significant difference between the two groups (P 0.05). There was no thrombocytopenia during hospitalization. There was no significant difference in the incidence of MACE between the two groups after 24 weeks follow-up (P 0.05 vs 22. 5). Conclusion: when patients with STAMI are undergoing emergency PCI, the coronary artery blood flow can be improved effectively by intracoronary administration of etibapeptide. Increased myocardial perfusion significantly improved the cardiac function of the patients. The risk of massive hemorrhage was not increased by intracoronary administration of etibapeptide, and 24 weeks follow-up showed no increase in the incidence of MACE.
【作者单位】：河北医科大学第二医院心内科;
【分类号】：R542.22

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