冠脉内注射法舒地尔对STEMI患者急诊PCI术中无复流的疗效观察

闫生玲，周静，高峰

(延安大学附属医院心脑血管专科病区，陕西延安716000)

摘要：目的观察冠状动脉内注射法舒地尔对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术中无复流的临床疗效。方法STEMI行急诊PCI术中出现无复流患者60例，随机分成观察组30例(冠状动脉内注射法舒地尔5 mg)和对照组30例(冠状动脉内注射硝酸甘油200μg)。根据冠状动脉内注入药物5 min后的冠状动脉造影结果评定冠脉血流速度，观察术中TIMI血流分级、计算CTFC计帧数、术后24 h心电图STR，术后1周LVEF，低血压、出血及术后60 d内MACE事件发生率情况，将试验组与对照组进行比较。结果观察组TIMI血流3级比例明显高于对照组，而CTFC计帧数明显低于对照组(P<0.05)；观察组ST段完全回落率、术后1周左室射血分数均明显高于对照组，而术后60 d内MACE事件发生率均明显低于对照组，差异有统计学意义(P<0.05)；两组低血压、出血并发症发生率比较差异无统计学意义(P>0.05)。结论冠状动脉内注射法舒地尔能有效改善STEMI患者急诊PCI术中出现无复流后的冠状动脉血流，且安全性较高。

关键词：ST段抬高型心肌梗死；经皮冠状动脉介入治疗；法舒地尔；无复流

中图分类号：R542.2+2

作者简介：闫生玲(1986—)，女，陕西吴起人，延安大学附属医院硕士研究生。

[收稿日期2014-12-02；责任编辑梁毅]

Clinical observation of fasudil treatment on no-flow phenomenon

in patients with acute ST-elevation myocardial infarction during PCI

YANSheng-ling,ZHOUJing,GAOFeng

(Depatment of cardiovascular specialist ward,Affiliated Hospital of Yanan University,Yanan 716000,China)

Abstract：Objective To observe the influence of fasudil treatment on no-flow phenomenon in patients with acute ST-elevation myocardial infarction(STEMI) during percutaneous coronary intervention(PCI).Methods Sixty STEMI patients with no-reflow phenomenon during PCI were randomly divided into observation group of 30 cases (intracoronary injection of fasudil 5 mg) and control group of 30 cases (intracoronary injection of nitroglycerin 200μg).After injection of the drug 5 min to assessment of coronary flow velocity with coronary angiography,the thrombolysis in myocardial infarction (TIMI) flow grade, the corrected TIMI frame count (CTFC),24 hours ECG ST-segment degree of recovery,left ventricular ejection fraction after one week,hypotension, bleeding,and the incidence of major adverse cardiovascular events (MACE) in 60 days were observed. The test group was compared with the control group.Results The TIMI flow class 3 ratio in observation group was obviously higher than control group; CTFC meter frames was significantly lower than the control group(P<0.05);incidence of MACE within 60 days of postoperative events were significantly lower than the control group,and the difference was statistically significant(P<0.05);two groups of low blood pressure and bleeding complications were no statistically significant difference(P>0.05).Conclusion Intracoronary injection of fasudil can effectively improve the emergency PCI in patients with STEMI intraoperative appear no reflow after coronary blood flow, and high safety.

Key words：STEMI; Percutaneous coronary interventi; Fasudil; No-reflow

急诊PCI可快速开通梗死相关动脉(IRA)，有效恢复前向血流，是恢复心肌再灌注最为安全、有效的方法，但术中无复流现象直接影响手术成功率及患者预后。本研究探讨冠脉内注射法舒地尔对STEMI患者急诊PCI术中无复流的疗效，报道如下。

1.1研究对象

2012-12~2014-06本院收治的STEMI患者行急诊PCI，梗死相关动脉术前TIMI≤l级的患者60例，男性40例，女性20例，年龄27～70，平均(57.0±11.3)岁，随机分为观察组和对照组各30例。……