摘要
目的探讨急性冠状动脉（冠脉）综合征（ACS）患者急诊经皮冠脉介入治疗（PCI）时冠状动脉内应用维拉帕米的近期疗效和安全性。方法同期开放标签随机对照临床试验，入选我院2009年4月至2011年5月ACS患者98例。在应用阿司匹林、氯吡格雷、低分子肝素的基础上，数字抽签随机分为维拉帕米组（48例）和对照组（50例），维拉帕米组在支架释放后即刻将维拉帕米200pig加入2ml肝索生理盐水行冠脉内注入，对照组在支架释放后即刻冠脉内注入肝素生理盐水2ml。比较两组PCI术前、术后和冠脉内注药后的冠脉灌注和心肌灌注水平；并比较两组住院、随访期间主要心脏不良事件的发生率。结果两组间冠脉支架释放后即刻冠脉灌注和心肌灌注水平比较，差异无统计学意义（P〉O．05）；维拉帕米组冠脉内注入维拉帕米后校正的心肌梗死溶栓试验（TIMI）帧数（CTFC）（t=6，47，P〈0．01）、梗死相关血管的TIMI血流分级（X2=5．17，P〈0．01）、TIMI心肌灌注分级（TMPG，X2=8．25，P〈0．01）和心肌灌注显影分级（MBG，X2=2．12，P〈0．05）均较对照组改善；经对维拉帕米应用影响因素校正后，CTFC仍有改善（X2=2．36，P〈0．05），TFG（X2=0．58，P〉0．05）、MBG（X2=0．91，P〉0．05）有改善的趋势，维拉帕米组和对照组TMPG比较，差异无统计学意义（X2=0．68，P〉0．05）。两组PCI术后1周心脏超声检查结果差异无统计学意义（X2=0．65，P〉0．05）；两组住院期间、术后1个月和3个月随访期主要心脏不良事件发生率分别为12．5％（6例）和14．0％（7例），差异无统计学意义（X2=0．71，P〉0．05）。结论老年ACs患者急诊经PCI治疗时冠脉内应用维拉帕米可改善相关血管的TIMI血流，老年患者可耐受，安全可靠，可在临床推广应用。
Objective To examine the clinical efficacy and safety of intraeoronary verapamil during pereutaneous coronary intervention（PCl） in patients with acute coronary syndromes （ACS）. Methods Totally 98 patients with ACS undergoing PCI were randomly assigned to two groups： verapamil group （immediately intracoronary verapamil 200 ug/2 ml heparinised saline, n= 48） and intraeoronary saline control group （immediately intraeoronary 2 ml heparinised saline, n= 50） after deploying stent. The follow up time was 3 months. Thrombolysis in myocardial infarction （TIMI） flow grade （TFG）, corrected TIMI frame count （CTFC）, TIMI myocardial perfusion grade （TMPG）, myocardial blush grade （MBG） were assessed pre- and post-PC1 and after drug administration. Echocardiography were performed one week after PCI. Incidence of major adverse cardiac events in hospital and 3 months follow-up were compared between the two groups. Results The differences in values of CTFC, TFG, TMPG, MBG after PCI were not found between two groups （P〉 0.05）. However, after intracoronary drug administration, verapamil group was superior to control group in terms of CTFC （t=6.47, P〈0. 01）, TFG （X2=5.17, P〈0. 01）, TMPG（X2= 8.25, P%0.01）and MBG（X2=：2.12, P〈0.05）. After correcting the influencing factors, only CTFC was still improved in verapamil group than in control group （Z2 = 2.36, P〈0.05）. There were no significant differences between the two groups in TFG（X2= 0.58, P〉0.05）and MBG（X2 = 0.91, P〉0.05） and TMPG （X2 =0.68, P〉0.05）. Echocardiographic results after PCI were similar between two groups （X2=0.65, P〉0.05）. There was no difference in major adverse cardiac events between two groups （X2 = 0.71, P 〉 0.05 ）. Conclusions Application of intracoronary verapamil after deploying stent is effective, safety and worthy of popularization in view of improving post procedural coronary flow in patients with ACS.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2012年第4期290-293,共4页
Chinese Journal of Geriatrics
