替罗非班在高龄急性ST段抬高心肌梗死患者急诊介入治疗中的安全性和有效性  

Effect and safety of tirofiban in emergent interventional treatment for elder patients with acute ST segment elevation myocardial infarction

作　　者：雷力成[1] 彭建军[1] 梁雅[1] 杨诺[1] 唐建春[1] 王佐岩[1] 杨水祥[1] 

机构地区：[1]北京世纪坛医院心内科,北京100038

出　　处：《解放军医学杂志》2008年第4期372-374,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的评价血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班应用于高龄急性ST段抬高性心肌梗死(STEMI)患者急诊介入治疗(PCI)的安全性和有效性。方法65例行急诊PCI的急性STEMI患者按照年龄分为高龄组(≥70岁,n=31)和非高龄组(<70岁,n=34),所有患者术前常规联合应用阿司匹林和氯吡格雷,术中使用肝素和替罗非班,观察PCI术后48h和30d的不良心血管事件(再发心绞痛、心肌梗死、靶血管再次重建和猝死)、出血事件以及血小板减少等副反应的发生情况。结果高龄组患者的多支血管病变比例(77%)高于非高龄组(35%,P<0.01);PCI术后48h及30d,两组均无死亡及靶血管再次重建病例。术后48h,两组均无心绞痛及心肌梗死发生病例。术后30d,高龄组有1例发生心绞痛,1例再发心肌梗死;非高龄组有2例发生心绞痛,无再发心肌梗死发生。两组不良心血管事件的发生率无统计学差异(P>0.05)。术后48h,高龄组有2例发生穿刺部位血肿,1例大便化验潜血阳性;非高龄组1例发生穿刺部位血肿,1例镜下血尿,1例牙龈出血。术后30d,两组均无出血事件发生。两组均无颅内出血及消化道大出血,无血小板减少发生。两组总的出血及血小板减少副反应发生率无统计学差异(P>0.05)。结论高龄急性STEMI患者急诊PCI中应用替罗非班是安全有效的。Objective To evaluate the effect and safety of use of tirofiban in percutaneous coronary interventional therapy （PCI） in elder patients with acute ST segment elevation myocardial infarction （STEMI）. Methods Sixty-five patients with acute STEMI were divided into two groups： 31 patients in the elderly group （≥70 years） and 34 patients in the younger group （〈70 years）. The clinical data were recorded and analyzed, including clinical characteristics, main adverse cardiac events （MACE） such as recurrent angina, myocardial infarction and target vessel revascularization, and the adverse effects such as sudden death, hemorrhage and thrombocytopenia. Results The elderly group had more patients with multi-vessel disease compared with that in younger group （77% vs 35%, P〈0.01）. No MACE occurred in both groups within 48 hours after PCI. In the elderly group, recurrent angina occurred in 1 case and myocardial infarction in another case within 30 days after PCI. While in the younger group, recurrent angina occurred in 2 patients and no occurrence of myocardial infarction. No death and target vessel revascularization occurred in the both groups. There were 3 cases of minor bleeding in each group respectively within 48 hours after PCI, and no major bleeding and thrombocytopenia till 30 days after PCI. No significant difference was found in MACE occurrence and adverse effects between the two groups （P〉0.05）. Conclusion It is safe and effective to administer tirofiban to elderly patients with acute STEMI undergoing PCI.

关 键 词：替罗非班 冠状动脉疾病 老年人 血管成形术 

分 类 号：R542.220.5[医药卫生—心血管疾病]