国产盐酸替罗非班在急诊经皮冠状动脉介入治疗中临床应用的研究  

Clinic study of domestic tirofiban during primary percutaneous coronary intervention

作　　者：郭来敬[1] 唐强[1] 胡大一[2] 

机构地区：[1]北京大学首钢医院心脏中心,北京100041 [2]北京大学人民医院心内科,北京100044

出　　处：《临床荟萃》2006年第23期1697-1700,共4页Clinical Focus

摘　　要：目的评价血小板糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂(国产盐酸替罗非班),对S-T段抬高型急性心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)冠状动脉再灌注的影响及安全性和有效性。方法选择2004年3月至2006年6月,急诊入院STEMI患者68例,分为试验组(盐酸替罗非班+PCI)37例,对照组(直接PCI)31例;收集所有病例的临床和冠状动脉造影资料,观察PCI术前、术后心肌梗死溶栓治疗在临床试验中用冠状动脉造影评价冠状动脉再灌注的标准(TIMI)中主要不良心血管事件(死亡、新近心肌梗死和顽固缺血状态)、左室射血分数(LVEF)及药物不良反应(出血、血小板减少)。结果试验组于术前应用盐酸替罗非班使PCI前梗死相关动脉(IRA)血流分级提高,与对照组比较,差别有统计学意义(P<0.01);PCI术后两组患者TIMI分级差异无统计学意义,再灌注心律失常低于对照组(5.4%vs 22.6%),住院期间不良心血管事件(MACE)发生率,试验组低于对照组(5.4%vs12.9%),但差异无统计学意义(P>0.05)。术后试验组LVEF高于对照组[(58.2±6.0)%vs(50.4±10.6)%,P<0.05];两组均未发生严重出血并发症(包括大量出血和颅内出血等),出血事件发生率试验组较对照组有增多的趋势但差异无统计学意义(10.8%vs 3.2%,P>0.05)。结论Ⅱb/Ⅲa受体抑制剂盐酸替罗非班可改善STEMI患者梗死相关动脉(IRA)的TIMI血流,血小板GPⅡb/Ⅲa受体拮抗剂盐酸替罗非班联合PCI是STEMI患者急诊PCI安全和有效的再灌注手段。Objective To assess thrombolysis in myocardial infarction （TIMI） flow,the safety and efficacy of the national produced tirofiban in patients with ST-segment elevation myocardial infarction （STEMI） during primary percutaneous coronary intervention （PCI）. Methods Sixty-eight patients with STEMI during primary PCI from March 2004 to June 2006 were divided into two groups,experimental group （tirofiban＋PCI） 37 cases,control group （primary PCI） 31 cases. TIMI flow before and after operation including death, new onset myocardial infarction, persistent myocardial ischemic state, post-operation left ventricular ejection fraction（LVEF） and adverse drug effect （bleeding, platelet reduction） were observed in all cases. Results By using tirofiban before operation improved TIMI flow,TIMI flow of infarction related artery （IRA） in experimental group was higher as compared with control group（ P 〈0.01）, There was no difference between two groups in TIMI grade flow after operation （ P 〉0. 05）. Reperfusion arrhythmia was less in experimental group （5.4% vs 22.6%, P 〈0.05）. MACE rates in hospital experimental group was lower than that in control group（5.4% vs 12.9%, P 〉0.05） ,post-operation LVEF experimental group was more than that in control group （58.2 ± 6.0 vs 50.4 ± 10.63） （ P 〈 0.05）. There were no severe hemorrhage complications （severe hemorrhage or cerebral hemorrhrage） in both groups. The bleeding events tended to be higher in experimental group （10.8% vs 3.2%, P 〉0.05）. Conclusion＇ Tirofiban may improve TIMI flow of the IRA in patients with STEMI during emergency PCI, tirofiban ＋PCI is possible to become safe and effective reperfusion method.

关 键 词：心肌梗塞 血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂 血管成形术 经腔 经皮冠状动脉 

分 类 号：R542.22[医药卫生—心血管疾病]