| Objective: The aim of this study was to investigate the preventive use of sodium nitroprusside and diltiazem in patients with acute ST-segment elevation myocardial infarction(STEMI) after balloon dilatation of infarction-related artery(IRA) in primary PCI(PCI) with coronary artery disease.The effect of no-reflow phenomenon on coronary artery during operation.Methods: The STEMI patients who need emergency PCI from December 2016 to December 2018 were selected as the study subjects.Except for the patients whose IRA was not opened,the patients whose heart function was above grade ?(Killip < 3),the patients with left main lesions,liver failure,renal failure,lung failure,etc.The patients with hypotension(systolic pressure < 90 mmHg or diastolic pressure < 60 mmHg)/the patients with bradyarrhythmia(such as ventricular rate below 60 beats/points) should be excluded.All patients included in this study were randomly divided into A and B groups according to the random number table method.After balloon dilatation,group A was given sodium nitroprusside 200 ug/8 ml 0.9% sodium chloride injection by catheter,which was highly selective and slowly injected near the lesion of coronary artery(5 mm far from the target vessel).Group B was treated with sodium nitroprusside 200 UG and diltiazem 8 ml(125 ug/ml) and injected slowly at the same place in the same way as group A.The blood pressure and heart rate of all patients should also be closely monitored during injection.Observation indexes: Baseline data such as age,sex,stent diameter,heart rate and mean arterial pressure before and after interventional therapy,thrombolysis in myocardial infarction(TIMI) blood flow grading,TIMI myocardial perfusion(TMPG) grading,incidence of no reflux,left ventricular ejection fraction(Left ventricular ejection fraction) 1 week and 3 months after interventional therapy.Ejection fraction(LVEF);ST segment regression rate(STR) 90 minutes after operation;major adverse cardiovascular events(MACEs) during admission and 3 months after operation.Result:1.Baseline data: Eighty-five patients met the criteria in this study,42 in group A and 43 in group B.There was no significant difference in baseline data of mean arterial pressure,number of diseased vessels,location of infarction-related arteries,number of stents,length and diameter between the two groups(P > 0.05).2.There was no significant difference in TIMI blood flow grading between the two groups before and after operation(P > 0.05).There was no significant difference in TMPG grade between groups A and B before operation(P > 0.05).There was significant difference in TMPG grade between the two groups(P=0.034) after operation.In the two groups,TMPG grade 0(0% vs 7.14%),TMPG grade 1(9.30% vs 0%),TMPG grade 2(4.65% vs 28.57%) and TMPG grade 3(86.05% vs 64.29%) respectively.3.There was a difference in STR at 90 minutes after operation between group A and group B.Compared with group A,the STR at 90 minutes in group B was significantly higher than that in group A(55.84 ±8.57 vs 52.12 ±8.13)(P=0.043).There was no significant difference in LVEF between the two groups one week after operation(P > 0.05),but the LVEF of group B was significantly higher than that of group A(56.30 ±5.44 vs 54.19 ±4.17) three months after operation(P=0.048).There was no significant difference in MACEs between the two groups in hospital and 3 months after operation(P > 0.05).Conclusion: During primary PCI,After balloon dilatation and opening of IRA,Intracoronary prophylactic combination of sodium nitroprusside and diltiazem can increase myocardial perfusion and may improve cardiac function. |
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