Gan Li-jun, Zhang Chun-hui, Zhang Meng
Department of Cardiology, The Affiliated Hospital of Jining Medical College, Shandong.
Zhongguo Zhong Xi Yi Jie He Za Zhi. 2010 Apr;30(4):348-51.
To evaluate the effect and safety of Xuesaitong (XST, a Panax Notoginseng extract preparation) via intracoronary injection for treating post-PCI slow-reflow phenomenon in patients with ST-segment elevation myocardial infarction (STEMI) and its impact on patients' prognosis.
Thirty-nine STEMI patients who suffered from post-PCI slow-reflow after received percutaneous transluminal coronary angioplasty or stenting were assigned to two groups, 20 patients in the treated group and 19 in the control group. Intracoronary administering of 10 mL (0.5 mg) tirofiban and 400 mg XST were given to the treated group through guiding catheter, and followed with 36 h continuous intravenous dripping of tirofiban 10 mL/h and 400 mg XST in 250 mL of saline for dripping, while to the control group, the same intracoronary administering and intravenous dripping of tirofiban but without XST was given. The treatment was implemented for two days. Patients' coronary flow was assessed by the TIMI frame count method (TFC) at 1 min, 5 min and 10 min after injection; and the changes of ST-segment in 2 h, and incidence of bleeding in 48 h after medication were recorded. All patients were followed-up for 6 months to observe the incidence of cardiovascular events.
Before the medication, the TIMI flow grade and the TFC in the treated group and the control group showed insignificantly statistical difference between groups (P > 0.05). After medication, 11 patients (55%) in the treated group and 8 patients (42%) in the control group with their blood flow reaching TIMI grade 3; the TFC decreased at 1, 5 and 10 min to 57.6 +/- 12.6, 46.1 +/- 9.3, 49.8 +/- 10.9 in the treated group and to 69.3 +/- 16.1, 61.2 +/- 15.3, 63.7 +/- 18.3 in the control group; and the 2 h ST segment fallback in them was 1.85 +/- 0.31 mm and 1.40 +/- 0.21 mm respectively, showing that the coronary blood flow in both groups were improved significantly after medication but the improvement in the former was better than in the latter group (P < 0.05). No case of death occurred in the hospitalization period. Results of 6-month follow-up study showed that the incidence of major adverse cardiac events, including angina pectoris, myocardial infarction, heart failure and cardiac death, was 33% in treated group and 44% in the control group, showing insignificant difference between groups (P > 0.05).
Concomitant coronary injection with tirofiban and XST is more effective than that with tirofiban alone in improving the coronary blood flow and shows no increasing on the incidence of hemorrhagic complication.
评价冠状动脉内注射血塞通（XST，一种三七提取物制剂）对ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后慢血流现象的疗效及安全性，及其对患者预后的影响。
39例接受经皮腔内冠状动脉成形术或支架置入术后出现PCI后慢血流的STEMI患者被分为两组，治疗组20例，对照组19例。治疗组经引导导管冠状动脉内给予10 mL（0.5 mg）替罗非班和400 mg血塞通，随后以10 mL/h的速度持续静脉滴注替罗非班10 mL并将400 mg血塞通加入250 mL生理盐水中静脉滴注36 h，而对照组冠状动脉内给予相同剂量的替罗非班并静脉滴注，但不使用血塞通。治疗持续两天。注射后1分钟、5分钟和10分钟采用心肌梗死溶栓试验（TIMI）帧数法（TFC）评估患者冠状动脉血流；记录用药后2小时ST段变化及48小时内出血发生率。所有患者随访6个月，观察心血管事件发生率。
用药前，治疗组和对照组的TIMI血流分级和TFC组间差异无统计学意义（P>0.05）。用药后，治疗组11例（55%）、对照组8例（42%）患者血流达到TIMI 3级；治疗组1分钟、5分钟和10分钟时TFC分别降至57.6±12.6、46.1±9.3、49.8±10.9，对照组分别降至69.3±16.1、61.2±15.3、63.7±18.3；两组用药后2小时ST段回落分别为1.85±0.31 mm和1.40±0.21 mm，表明两组用药后冠状动脉血流均显著改善，但治疗组改善优于对照组（P<0.05）。住院期间无死亡病例。6个月随访研究结果显示，治疗组主要不良心脏事件（包括心绞痛、心肌梗死、心力衰竭和心源性死亡）发生率为33%，对照组为44%，组间差异无统计学意义（P>0.05）。
冠状动脉内联合注射替罗非班和血塞通在改善冠状动脉血流方面比单独注射替罗非班更有效，且出血并发症发生率未增加。
