中文摘要：

目的观察梗死相关动脉(IRA)内血栓抽吸联合替罗非班注射对急性ST段抬高型心肌梗死(STEMI)的疗效。方法选择STEMI患者180例,随机分为三组,每组60例。A组给予IRA内血栓抽吸及替罗非班注射+经皮冠状动脉介入治疗(PCI),B组给予IRA内血栓抽吸+PCI,C组给予PCI。PCI术后1天(基础状态)及1年时进行心脏彩色多普勒超声检查,观察左心室收缩末期容积指数(LVESVI)、左心室舒张末期容积指数(LVEDVI)、左心室射血分数(LVEF)及心室重构情况。比较三组术后1周内出血情况及术后1年内不良心血管事件发生情况。结果 175例患者完成1年随访观察,A组1例于PCI术后第5天因心脏破裂死亡,B组2例、C组2例于PCI术后1年内发生心源性猝死。术后1年时,与B、C组比较,A组LVEDVI、LVESVI降低(P均<0.05),LVEF升高(P均<0.05);A组4例(6.7%)、B组12例(20.6%)、C组17例(29.3%)发生心室重构,A组心室重构率低于B、C组(P均<0.05);A组发生心绞痛复发3例、心功能不全2例、心源性猝死1例,不良心血管事件发生率为10.1%,B组分别为7、5、2例和24.1%,C组分别为9、8、2例和32.7%,A组不良心血管事件发生率低于B、C组(P均<0.05)。术后1周内三组均出现皮肤、黏膜、穿刺部位及牙龈轻度出血,无大出血或严重出血,三组出血情况比较,P均>0.05。结论 IRA内血栓抽吸联合替罗非班注射能够减少STEMI患者行PCI后心室重构发生,改善心脏功能,降低不良心血管事件的发生,且不增加出血风险。

英文摘要：

Objective To observe the efficacy of thrombus aspiration and tirofiban injection in the infarct-related ar-tery (IRA) during primary percutaneous coronary intervention (PCI) for patients with ST-elevation acute myocardial infarc-tion ( STEMI) .Methods A total of 180 STEMI patients were randomly divided into three groups, 60 cases in each group:group A which received the IRA thrombus aspiration and tirofiban injection+PCI, group B which received IRA thrombus aspiration +PCI and group C treated with PCI.The color Doppler ultrasound examination was performed at 1 day and 1 year after PCI to observe the left ventricular end systolic volume index ( LVESVI) , left ventricular end diastolic vol-ume index ( LVEDVI) , left ventricular ejection fraction ( LVEF) and ventricular remodeling.Hemorrhage events in a week and the cardiovascular events in a year among three groups were compared.Results After 1-year follow-up of 175 cases, 1 case in the group A died of cardiac rupture on the fifth day after PCI;2 cases in the group B and 2 cases in the group C died of sudden cardiac death in one year after PCI.One year after operation, LVEDVI and LVESVI were decreased, LVEF was increased in the group A as compared with those of the group B and group C ( all P<0.05);the ventricular remode-ling was found in 4 cases (6.7%) of group A, 12 cases (20.6%) in the group B and 17 cases (29.3%) in the group C, and the remodeling rate of group A was lower than those of group B and group C ( all P<0.05);in the group A, angina re-currence occurred in 3 cases, cardiac insufficiency was found in 2 cases, sudden cardiac death was found in 1 case, and the incidence of adverse cardiovascular events was 10.1%, in the group B, they were 7, 5, 2 cases and 24.1%, respec-tively, 9, 8, 2 cases and 32.7%in the group C, respectively, and the incidence of adverse cardiovascular events of group A was lower than that of group B and group C (all P<0.05).One week after operation in the three groups, the mild bleeding was found in the skin, mucous membrane, p