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目的探讨经靶向灌注导管对急性ST段抬高型心肌梗死(STEMI)患者梗死相关动脉(IRA)远端应用替罗非班和硝酸甘油并置入支架术后进行球囊后扩张(PSBD)对冠状动脉血流的影响。方法回顾性分析102例行直接经皮冠状动脉介入治疗(PCI)的STEMI患者,支架置入后均行PSBD。随机分为试验组48例,支架置入前预防性靶向灌注替罗非班和硝酸甘油;对照组54例,直接行支架置入。比较两组患者心外膜冠状动脉灌注水平及心肌灌注水平、术后出血事件发生率及术后30天主要不良心脑血管事件(MACCE)发生率。结果试验组PCI术中心外膜灌注及心肌组织灌注水平显著高于对照组(P=0.0044、P=0.0389),术后出血事件发生率及术后30天主要不良心脑血管事件发生率差异无显著性(P>0.05)。结论经靶向灌注导管行IRA远端逆向应用血小板糖蛋白Ⅱb/Ⅲa抑制剂替罗非班和硝酸甘油的STEMI患者支架置入后球囊后扩张是安全的,冠脉慢/无复流现象发生率明显降低,且不增加术后出血事件的发生率和术后MACCE发生率。
Objective To investigate the effect of targeted infusion catheter on the distal application of tirofiban and nitroglycerin in patients with acute ST - segment elevation myocardial infarction (STEMI) undergoing stent implantation and balloon dilatation (PSBD) Impact on coronary blood flow. Methods A total of 102 STEMI patients undergoing direct percutaneous coronary intervention (PCI) were retrospectively analyzed. PSBD was performed after stent implantation. Randomly divided into experimental group of 48 patients, prophylactic targeted infusion of tirofiban and nitroglycerin before stent implantation; control group of 54 patients received direct stent implantation. The level of epicardial coronary artery perfusion and myocardial perfusion, the incidence of postoperative bleeding and the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) at 30 days after surgery were compared between the two groups. Results The level of epicardial perfusion and myocardial perfusion in the PCI group was significantly higher than that in the control group (P = 0.0044, P = 0.0389). The incidence of postoperative bleeding and the incidence of major adverse cardiovascular and cerebrovascular events 30 days after PCI Significance (P> 0.05). CONCLUSION: Post-stent dilatation of STEMI patients treated with target-loaded infusion of IRA distal to platelet glycoprotein Ⅱb / Ⅲa inhibitor tirofiban and nitroglycerin is safe and slow / no-reflow phenomenon The incidence was significantly reduced, and did not increase the incidence of postoperative bleeding and postoperative MACCE incidence.