替罗非班对急性心肌梗死急诊介入治疗后微血管功能不全和早期左心室重构的影响  

Effects of Tirofiban on Microvascular Dysfunction and Early Left Ventricular After Remodeling Primary Percutaneous Coronary Intervention

作　　者：谢晓春[1] 刘胜林[1] 杨军珂[1] 李元风[2] 赵贵峰[1] 胡丽华[1] 白玉蓉[1] 丁力平[1] 

机构地区：[1]中国人民解放军第二炮兵总医院心内科,北京市100088 [2]哈尔滨市黑龙江省医院南岗分院心内科

出　　处：《中国循环杂志》2007年第4期267-270,共4页Chinese Circulation Journal

摘　　要：目的:探讨急性心肌梗死(AMI)急诊直接经皮冠状动脉介入治疗(PCI)术中应用血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班对冠状动脉微血管功能不全和早期左心室重构的影响。方法:104例AMI接受急诊直接PCI患者随机分成治疗组(替罗非班)52例和对照组52例。比较两组术后即刻心肌梗死溶栓治疗临床试验(TIMI)分级、计算校正TIMI计帧数(cTFC)和心肌Blush分级。采用彩色多普勒心动超声仪分别于发病后早期(<24小时即基线)、1、2、3周末连续测量、计算左心室形态、构型等多项指标。结果:两组患者中TIMI3级血流无显著差异(P>0.05),而治疗组中cTFC显著低于对照组(P<0.05),心肌Blush分级获得率比对照组显著增高(P<0.05)。对照组左心室形态和构型变化比治疗组显著加重(P<0.05),且1周末到3周末呈进行性加重,3周末最明显。结论:AMI患者急诊直接PCI术中应用替罗非班可有效改善PCI术后微血管功能不全,对左心室重构有显著抑制作用。Objective：To study the effects of glycoprotein II b/Ⅲ a receptor blockade with tirofiban on microvascular dysfunction and early left ventricular remodeling（LVR） in patients with acute myocardial infarction（AMI） treated by primary percutaneous coronary intervention （PCI）. Methods：One hundred and four patients with first AMI were randomized to receive either tirofiban and primary PCI（ n = 52） or primary PCI alone （ n = 52）. TIMI grade, corrected TIMI frame count（cTFC） and myocardial blush grade were compared immediately after primary PCI. The indexes of left ventricular shape, geometry were measured at early （ 〈 24 h ）, 1,2 and 3 weekends after AMI by echocardiography. Results：There was no difference between two groups in TIMI frame 3 flow（ P 〉 0. 05 ）. Fewer cTFC（ P 〈 0. 05 ） and higher myocardial blush grade 3 （76. 9% vs 53.8% ,P 〈 0. 05 ）were obtained in tirofiban group. The changes of left ventricular shape and geometry in control group were more obvious than tirofiban group,and progressively worsened from 1 to 3 weeks ,reading the most obvious peak value 3 weeks（P 〈0. 05）. Conclusion：Tirofiban in patients with AMI after primary PCI was more effective in inhibitory action of LVR and in the improvement of microvascular dysfunction.

关 键 词：替罗非班 心肌梗塞 介入治疗 微血管功能 左心室重构 

分 类 号：R541[医药卫生—心血管疾病]