早期应用替罗非班对急诊冠脉介入术后心肌微循环再灌注的影响  

Effects of tirofiban on improving myocardium reperfusion in patients with acute ST segment elevation myocardial infarction after emergency percutaneous coronary intervention

作　　者：李瑞建[1] 陈玉国[1] 张运[2] 孙祎[1] 徐峰[1] 吕瑞娟[1] 纪求尚[2] 李继福[2] 李贵双[2] 

机构地区：[1]山东大学教育部和卫生部心血管重构与功能研究重点实验室山东大学齐鲁医院急诊科,山东济南250012 [2]山东大学教育部和卫生部心血管重构与功能研究重点实验室山东大学齐鲁医院心内科,山东济南250012

出　　处：《中国新药与临床杂志》2007年第3期207-211,共5页Chinese Journal of New Drugs and Clinical Remedies

摘　　要：目的:探讨早期应用替罗非班对直接经皮冠脉介入术(PCI)术后心肌微循环再灌注的影响。方法:初发ST段抬高急性心肌梗死(STEMI)拟行直接PCI术病人131例,A组(n=32,阿司匹林、氯吡格雷和替罗非班),B组(n=99,阿司匹林和氯吡格雷)。全部病人即刻嚼服阿司匹林300 mg,后100 mg·d^(-1);口服氯吡格雷300 mg,后75 nag·d^(-1)。A组再给予替罗非班注射液10μg·kg^(-1)负荷剂量,推注3 min,而后0．15μg·kg^(-1)·min^(-1)持续静脉滴注48 h。入选后即刻测定血小板聚集率、活化状态及心电图,24 h和72 h复查。结果:入选24 h后,A组血小板聚集率及活化状态较B组明显下降(P＜0．05),ST段完全回落率明显高于B组(P＜0．05)。与B组相比,A组梗死相关动脉(IRA)狭窄程度较轻[(69±s 11)％vs (87±8)％,P=0．03]。PCI术后心肌梗死溶栓试验(TIMI),血流3级A组高于B组(97％vs 82％, P=0．045),TIMI血流灌注分级(TMPG),3级A组高于B组(63％vs 42％,P=0．048)。治疗期间轻度血小板减少和出血A组高于B组(9％vs 1％,P=0．045)。随访30 d,2组死亡率无差异,但主要不良心脏事件(MACE)发生率A组低于B组(6％vs 27％,P=0．013),进一步分析A组严重心绞痛(6％vs 21％,P＜0．05)及靶血管再次血运重建术(6％vs 25％,P=0．021)较B组显著降低。结论:在阿司匹林和氯吡格雷基础上早期应用替罗非班,可进一步抑制血小板功能,减少STEMI再灌注后无再流或慢血流的发生,改善心肌微循环再灌注及病人预后。AIM： To evaluate the effects of tirofiban on coronary intervention （PCI）. METHODS： One hundred and myocardium reperfusion after primary percutaneous thirty-one patients with ST elevation acute myocardial infarction （ ≤12 h）, who underwent primary PCI, were randomized into two groups. Thirty-two patients in group A were treated with tirofiban, ninety-nine patients in group B were treated routinely without tirofiban. All patients were given aspirin and clopidogrel 300 mg at the time of grouping, then aspirin 100 mg·d^-1 and clopidogrel 75 mg·d^-1. Tirofiban was administered immediately after enrollment with a loading dose of 10 μg·kg^-1 for 3 min, followed by infusion of 0.15 μg·kg^-1·min^-1 for 48 h. Platelet aggregation and activation function, blood routines, blood coagulation routines and ECG were measured at 0, 24, 72 h. RESULTS： Compared with group B, residual stenosis of IRA （（69 ± s 11） % vs （87 ± 8） %, P〈 0.05） was light and TIMI grade 3 flow rate after PCI was high in group A （97 % vs 82 %, P 〈 0.05）. Normal TIMI myocardial perfusion grade （TMPG） 3 was 63 % in group A and 42 % in group B after PCI （P 〈 0.05）. During the follow-up of 30 days, there was no significant difference in cardiac death rate between two groups （0 % vs 3 %, P 〉 0.05）, but the major adverse cardiac events （including cardiac death, non-fatal myocardial reinfarction, target vessel revascularization and severe angina） were significantly less frequent in group A （6 % vs 27 %, P 〈 0.05）. Less patients in group A suffered from severe angina （6 % vs 21%, P 〈 0.05） and target vessel revascularization （6 % vs 25 %, P 〈 0.05）. Platelet aggregation and activation function decreased significantly in group A at 24 h from the onset of tirofiban infusion. The rate of complete ST segment resolution was significantly higher in group A than that in group B at 24 h and 7 d after primary PCI （P 〈 0.05）. CONCLUSION： Early application of tirofiban before primary PCI

关 键 词：替罗非班 血管成形术 经腔 经冠状动脉 心肌梗死 心肌再灌注 

分 类 号：R972.6[医药卫生—药品]