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, puncture sites and gingiva, but no massive hemorrhage or severe bleed-ing occurred, and no significant difference was found in bleeding among these three groups (all P>0.05).Conclusion Thrombus aspiration and tirofiban injection in the IRA during PCI can reduce ventricular remodeling of STEMI patients, im-prove the cardiac function, reduce the occurrence of cardiovascular events and do not increase the risk of hemorrhage.%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。
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