本文關(guān)鍵詞：經(jīng)改造球囊導(dǎo)管靶血管注射地爾硫卓對急性ST段抬高型心肌梗死患者直接經(jīng)皮冠狀動脈介入治療術(shù)中無復(fù)流的影響　出處：《河北醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 直接經(jīng)皮冠狀動脈介入 急性ST段抬高型心肌梗死 冠狀動脈無復(fù)流 靶血管給藥 地爾硫卓

【摘要】：目的：本研究旨在探討相對于傳統(tǒng)經(jīng)冠狀動脈指引導(dǎo)管給藥預(yù)擴后經(jīng)改造的預(yù)擴球囊靶血管注射地爾硫卓對急性ST段抬高型心肌梗死（STelevation myocardial infarction, STEMI）患者直接經(jīng)皮冠狀動脈介入治療（primary percutaneous coronary interventions, PPCI）中冠狀動脈無復(fù)流現(xiàn)象（coronary no reflow phenomenon, CNRP）的影響。 方法：入選2012年7月至2013年12月河北醫(yī)科大學(xué)第三醫(yī)院心內(nèi)科收治、明確診斷為STEMI并行PPCI患者隨機分為實驗組（n=49），對照組（n=51）。PPCI由有10年以上介入經(jīng)驗的心血管內(nèi)科主任醫(yī)師按標(biāo)準(zhǔn)操作施行，導(dǎo)絲、導(dǎo)管依解剖結(jié)構(gòu)選擇。術(shù)前完善心電圖、血壓測量及其他術(shù)前準(zhǔn)備，在PPCI中通過冠狀動脈造影判明梗死相關(guān)動脈（infarctionrelated artery, IRA），繼而送入指引導(dǎo)絲，并在對IRA病變處施行球囊預(yù)擴張。撤出預(yù)擴球囊后，保留指引導(dǎo)絲，實驗組以刀片縱向劃破使用過的預(yù)擴球囊，并經(jīng)改造的預(yù)擴球囊送達IRA病變處注射地爾硫卓稀釋液2mg，對照組則在預(yù)擴球囊撤出后經(jīng)指引導(dǎo)管于冠狀動脈口處注射等量地爾硫卓稀釋液。所有患者均植入藥物涂層支架，，術(shù)后依據(jù)病情由有5年以上工作經(jīng)驗的心血管內(nèi)科主治及以上醫(yī)師調(diào)整用藥，并隨訪至PPCI術(shù)后3個月。觀察兩組基線資料（包括年齡，性別，平均血壓，心率，吸煙史，家族史，既往心絞痛，合并癥（高血壓病、2型糖尿病、血脂異常），既往心肌梗死（myocardial infarction, MI）、PCI治療或行冠狀動脈旁路移植術(shù)（coronary artery bypass grafting, CABG），體重指數(shù)，發(fā)病時間，就診-球囊到位（Door-to-balloon, DTB）時間，Killip2級例數(shù)，術(shù)前用藥），冠狀動脈造影資料（包括PPCI時間，暴露時間，IRA分布，病變血管支數(shù)，支架直徑，支架長度，最大擴張壓力，擴張次數(shù)，指引導(dǎo)絲類型，指引導(dǎo)管類型，初始及支架植入后心肌梗死溶栓試驗（thrombolysis inmyocardial infarction, TIMI）血流分級、 TIMI心肌灌注分級（TIMImyocardial perfusion grade, TMPG）），術(shù)后心率、平均血壓水平，術(shù)后2小時有效ST段回落率（即PPCI術(shù)后2小時ST段抬高最高導(dǎo)聯(lián)ST段回落≥50%患者所占比例），術(shù)后1周左室射血分?jǐn)?shù)（left ventricle ejectionfraction, LVEF)，術(shù)后3個月主要心臟不良事件（major adverse cardiacevents, MACEs），術(shù)后用藥。CNRP定義為TIMI≤2級。 結(jié)果： 1基線資料：兩組在年齡，性別，平均血壓，心率，吸煙史，家族史，既往心絞痛，合并癥（高血壓病、2型糖尿病、血脂異常），既往MI、PCI及CABG情況，體重指數(shù)，發(fā)病時間， DTB時間，Killip2級例數(shù)，術(shù)前用藥無明顯統(tǒng)計學(xué)差異（P0.05）。 2PCI資料：兩組在PPCI時間，暴露時間，IRA分布，病變血管支數(shù)，初始TIMI情況，支架長度，支架直徑，支架數(shù)量，導(dǎo)絲類型，指引導(dǎo)管類型，擴張次數(shù)，最大擴張壓力，最大擴張壓力方面無統(tǒng)計學(xué)差異（P0.05），實驗組與對照組在支架植入后TMPG（P=0.034），支架植入后TIMI分級（P=0.036）有統(tǒng)計學(xué)差異，實驗組較對照組最終TMPG、TIMI分級改善，CNRP發(fā)生率降低。 3術(shù)后資料：實驗組較對照組術(shù)后平均血壓，術(shù)后心率，術(shù)后3個月MACEs發(fā)生率，術(shù)后用藥無統(tǒng)計學(xué)差異（P0.05）;兩組在術(shù)后2小時有效ST段回落率（30vs.21，P=0.045），術(shù)后1周LVEF(52.65±5.36%vs.50.33±4.50%, P=0.021)有統(tǒng)計學(xué)差異，實驗組較對照組有更高的術(shù)后2小時有效ST段回落率和術(shù)后1周LVEF水平。 結(jié)論：對于STEMI患者行PPCI時，經(jīng)改造的球囊導(dǎo)管于IRA病變處靶血管注射地爾硫卓較經(jīng)指引導(dǎo)管冠狀動脈內(nèi)給藥能夠增加梗死區(qū)域冠狀動脈血流和微灌注，降低CNRP的發(fā)生率，改善患者術(shù)后心功能。同時該方法不延長PPCI時間和暴露時間，對血壓、心率影響與經(jīng)指引導(dǎo)給藥無差異。
[Abstract]:Objective: This study aimed to investigate the relative to the traditional coronary artery guiding drug pre dilation after transformation of pre expansion balloon target vessel injection of diltiazem on acute ST elevation myocardial infarction (STelevation myocardial, infarction, STEMI) in patients with percutaneous coronary interventional therapy (primary percutaneous coronary interventions, PPCI) in coronary artery of no reflow phenomenon (coronary no reflow phenomenon, CNRP) effect.
Methods: selected from July 2012 to December 2013 admitted to the Department of Cardiology, the Third Hospital of Hebei Medical University, diagnosed as STEMI concurrent PPCI patients were randomly divided into experimental group (n=49), control group (n=51.PPCI) by more than 10 years experience in the cardiovascular physician operating purposes, according to the Standard Guide wire catheter according to the anatomic structure, perfect preoperative choice. The electrocardiogram, blood pressure measurement and other preparation before operation, in PPCI by coronary angiography (infarctionrelated artery, IRA to infarction), and then into the guide wire, and balloon dilation was performed in IRA lesions. The withdrawal of pre expansion balloon, retain the guide wire, the experimental group with longitudinal pre expanded cut blade the balloon used, and by the transformation of the balloon pre dilation delivered to IRA lesions injection of diltiazem diluted 2mg, the control group in the pre expanding balloon withdrawal after guiding catheter in the coronary artery at the mouth of note Shoot with diltiazem dilution. All patients were implanted with drug-eluting stents, cardiovascular medicine attending physicians and above the medication adjustment after surgery according to the disease by more than 5 years work experience, and follow up to 3 months after PPCI. Two groups were observed at baseline (including age, gender, mean blood pressure, heart rate, smoking history, family history, angina pectoris, comorbidities (hypertension, type 2 diabetes, dyslipidemia, previous myocardial infarction (myocardial), infarction, MI, PCI) treatment or coronary artery bypass grafting (coronary artery bypass grafting, CABG), body mass index, onset time, door to balloon in place (Door-to-balloon, DTB Killip2) time, the number of cases, preoperative medication), coronary angiography (including PPCI time, exposure time, IRA distribution, the number of diseased vessels, the diameter of the stent, stent length, maximum expansion pressure, the expansion of the number of guide wire type, refers to The guide tube type, thrombolysis in myocardial infarction and initial stent implantation (thrombolysis inmyocardial infarction, TIMI) flow grade, TIMI myocardial perfusion grade (TIMImyocardial perfusion grade), TMPG), postoperative heart rate, average blood pressure, 2 hours after the operation the effective rate of ST segment resolution (i.e., 2 hours after PPCI ST the highest elevation lead ST segment is more than 50% proportion of patients), 1 weeks after operation, left ventricular ejection fraction (left ventricle ejectionfraction, LVEF), after 3 months of major adverse cardiac events (major adverse, cardiacevents, MACEs), postoperative medication.CNRP defined as TIMI is less than or equal to 2.
Result錛

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