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目的探讨急性ST段抬高性心肌梗死(STEMI)急诊经皮冠状动脉介入治疗(PCI)时冠状动脉内应用维拉帕米对冠状动脉灌注、心肌灌注及临床预后的影响。方法本研究为前瞻性、随机、双盲、对照性临床研究。连续性入选99例STEMI拟行急诊PCI的患者,随机分为维拉帕米组与对照组。在支架释放后即刻,维拉帕米组在靶血管内注入维拉帕米200μg,对照组在靶血管内注入肝素生理盐水,比较两组PCI术前、术后和冠状动脉内注药后的冠状动脉灌注和心肌灌注的差别。冠状动脉灌注以心外膜TIMI血流(TFG)和校正的TIMI血流帧数计数(CTFC)来评价。心肌灌注以TIMI心肌灌注分级(TMPG)和心肌灌注显影(MBG)来评价。并比较两组在PCI术后1周心脏彩色超声结果、住院期间以及随访期间主要心脏不良事件(MACE)发生率上的差别。结果最终91例患者有完整资料,其中维拉帕米组47例,对照组44例,两组临床基本特征和造影特征相仿。维拉帕米组和对照组在术前和支架释放后即刻冠状动脉灌注和心肌灌注各指标差异均无统计学意义(P>0.05)。冠状动脉内注入维拉帕米后,维拉帕米组的CTFC、TFG、MBG、TMPG均较对照组有显著改善,分别为CTFC:27.1±14.2比39.0±23.8,P=0.011;TFG≥2级:100%比90.9%,P=0.035;MBG≥2级:91.5%%比75.5%,P=0.034;TMPG≥2级:89.4%比72.7%,P=0.042。维拉帕米组和对照组PCI术后1周时左室射血分数(63.4%±8.2%比63.5%±10.3%,P=0.578)、院内MACE发生率(4.3%比9.1%,P=0.613)和3个月MACE发生率(23.9%比22.7%,P=0.894)差异均无统计学意义。结论STEMI患者急诊行PCI治疗时,冠状动脉内应用维拉帕米可显著改善冠状动脉灌注和心肌灌注水平,但未观察到其对急诊PCI术后心室重构和短期临床预后的显著影响。
Objective To investigate the effect of intravenous application of verapamil on coronary artery perfusion, myocardial perfusion and clinical prognosis in patients with acute ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Methods This study was a prospective, randomized, double-blind, controlled clinical study. 99 consecutive STEMI patients enrolled in the emergency PCI were randomly divided into verapamil group and control group. Immediately after the stent was released, the verapamil group received 200 μg of verapamil in the target vessel, and heparin saline was injected into the target vessel in the control group. After PCI and before and after intracoronary injection, Coronary artery perfusion and myocardial perfusion differences. Coronary perfusion was assessed with epicardial TIMI flow (TFG) and corrected TIMI flow frame count (CTFC). Myocardial perfusion was assessed by TIMI myocardial perfusion grading (TMPG) and myocardial perfusion imaging (MBG). The differences in the incidence of major cardiac adverse events (MACE) between the two groups at 1 week after PCI were compared between the results of color sonography, hospitalization and follow-up. Results The final 91 patients with complete data, including verapamil 47 cases, control group 44 cases, the two basic clinical features and imaging features similar. There were no significant differences in the indexes of coronary perfusion and myocardial perfusion between the verapamil group and the control group immediately before operation and after stent release (P> 0.05). After intracoronary injection of verapamil, the CTFC, TFG, MBG and TMPG in verapamil group were significantly improved compared with the control group, which were respectively CTFC: 27.1 ± 14.2 vs 39.0 ± 23.8, P = 0.011; TFG≥2 Grade: 100% vs 90.9%, P = 0.035; MBG≥2: 91.5 %% vs 75.5%, P = 0.034; TMPG≥2: 89.4% vs 72.7%, P = 0.042. The LV ejection fraction (63.4% ± 8.2% vs. 63.5% ± 10.3%, P = 0.578), hospital MACE incidence (4.3% vs. 9.1%, P = 0.613) and 3-month MACE incidence (23.9% vs. 22.7%, P = 0.894). Conclusion Intracoronary administration of verapamil can significantly improve coronary perfusion and myocardial perfusion in STEMI patients undergoing PCI. However, no significant effect on ventricular remodeling and short-term clinical prognosis after emergency PCI was observed.