冠脉内替罗非班联合硝普钠预处理对NST-ACS患者PCI术中无复流的预防作用

目的:观察冠状动脉内注射替罗非班和硝普钠预处理对非ST段抬高型急性冠脉综合征(NST-ACS)患者经皮冠状动脉介入治疗(PCI)术中无复流的预防效果及对预后影响。方法:NST-ACS患者276例,被分为联合治疗组(124例,PCI术前冠脉内给予硝普钠+替罗非班预处理)和常规治疗组(152例,常规PCI术前处理)。观察两组患者PCI术中无复流发生情况,术后心肌梗死血流分级(TIMI),血清心肌肌钙蛋白I(cTnI)峰值以及住院期间和术后6个月主要不良心血管事件(MACE)发生率等。结果:与常规治疗组比较,联合治疗组患者术中无复流发生率(7.9%比2.4%)及术后24h血清cTnI峰值(2.85±0.92)ng/ml比(1.98±0.91)ng/ml]水平显著降低(P<0.05或<0.01);两组术后住院期间及6个月MACE发生率均无显著差异(P均>0.05)。结论:冠状动脉内注射硝普钠联合替罗非班术前预处理可预防非ST段抬高型急性冠脉综合征患者PCI术中的无复流现象发生,减少心肌损伤。

Preventive effect of intracoronary tirofiban combined sodium nitroprusside pretreatment on no-reflow during PCI in NST-ACS patients

Objective:To observe preventive effect of intracoronary injection of tirofiban and sodium nitroprusside pretreatment on no-reflow during percutaneous coronary intervention(PCI)in patients with non-ST elevation acute coronary syndrome(NST-ACS)and its impact on prognosis.Methods:A total of 276 NST-ACS patients were selected and divided into combined treatment group(n=124,received intracoronary sodium nitroprusside + tirofiban pretreatment before PCI)and routine treatment group(n=152,received routine treatment before PCI).Incidence of no-reflow during PCI,TIMI grade after PCI,serum peak level of cardiac troponin I(cTnI),incidence of major adverse cardiovascular events(MACE)during hospitalization and six months after PCI were observed in two groups.Results:Compared with routine treatment group,there were significant reductions in incidence rate of no-reflow during PCI(7.9% vs.2.4%)and serum peak value of cTnI on 24 hafter PCI(2.85±0.92)ng/ml vs.(1.98±0.91)ng/ml]in combined treatment group,P<0.05 or<0.01.There were no significant difference in incidence rates of MACE during hospitalization and six months after PCI between two groups,P>0.05 both.Conclusion:Intra-coronary injection of tirofiban combined sodium nitroprusside pretreatment before PCI can prevent no-reflow during PCI in NST-ACS patients.It can reduce myocardial injury also.