老年急性冠状动脉综合征患者介入术中应用替罗非班的疗效和安全性  

The efficacy and safety of tirofiban in the treatment of elderly patients with acute coronary syndrome during primary percutaneous coronary intervention

作　　者：胡承恒[1] 李怡[1] 李志明 罗初凡[1] 伍责富[1] 杜志民[1] 卢桂静[2] 

机构地区：[1]中山大学附属第一医院心内科,广州510080 [2]中南大学湘雅医院心内科

出　　处：《中华老年医学杂志》2009年第10期803-807,共5页Chinese Journal of Geriatrics

摘　　要：目的探讨老年急性冠状动脉综合征（ACS）患者经皮冠状动脉介入术（PCI）中应用替罗非班的疗效和安全性。方法将256例高危ACS患者，随机分为替罗非班组（替罗非班＋PCI，130例）和常规PCI组（126例），替罗非班组又根据年龄分为老年组（68例，≥60岁）和非老年组（62例，〈60岁）2个亚组。两组患者PCI术后罪犯血管的心肌梗死溶栓治疗（TIMI）3级血流达标率、校正的TIMI帧计数（CTFC）、心肌灌注分级（TMPG），以及36h和30d的主要心脏不良事件发生率作为疗效观察指标。并观察两组患者术后血小板减少和出血并发症的发生率。结果替罗非班组PCI术后TIMI3级血流发生率较常规PCI组高，但差异无统计学意义（93．6％比91．3％，X^2=1．02，P=0．313），TMPG3级所占比例替罗非班组高于PCI组（83．1％比67．5％，X^2=4．05，P=0．046），CTFC示替罗非班组血流快于PCI组（31．6±7．7比23．8±6．1，t=2．49，P=0．026）。两组在36h和30d的主要心脏不良事件发生率差异均有统计学意义（6．9％比19．0％，X^2=6．30，P=0．013；3．8％比11．90％，X^2=5．82，P=0．018）。与常规PCI组比较，替罗非班组TIMI轻度出血的发生率有增加趋势（20．2％比15．2％，X^2=3．65，P=0．065）。亚组分析表明，老年组轻度出血并发症的发生率较非老年组稍增高（25．0％比14．5Yoo，X^2=4．98，P=0．026），但两组严重出血事件发生率和血小板减少发生率均相似。结论老年ACS患者介入术中使用替罗非班是有效和安全的，其疗效优于常规治疗，但轻度出血风险有可能增加。Objective To investigate the efficacy and safety of tirofiban in the treatment of aged patients with acute coronary syndrome （ACS） during primary percutaneous coronary intervention （PCI）. Methods Two hundred and fifty six patients with ACS who underwent primary PCI were randomly divided into two groups： t irofiban group （tirofiban ＋ PCI treatment, n= 130） and control group （routine PCI treatment, n 126）. Tirofiban group was further divided into two subgroups according to the age： aged group（age ≥60 years, n=68） and non elderly group（age〈60 years, n= 62）. At the end of PCI procedure, angiographic features such as thrombolysis in myocardial infarction （TIMI） flow grade, corrected TIMI frames count and TIMI myocardial perfusion grades （TMPG） were analyzed immediately. The incidence of major adverse cardiac events （MACE） was observed within 36 hours and 30 days after PCI, and the incidence rates of thrombocytopenia and bleeding were assessed. Results There was no significant difference between both the two study groups and the two subgroups in the basic clinical or angiographic characteristics before PCI （all P〉0.05）. There was no significant difference between two groups in TIMI 3 flow achievement rate in culprit vessels after PCI （93.6G vs. 91.3%,X^2=1.02, P =0.313）. In tirofiban group, corrected TIMI frames count was significantly higher than that in control group （31.6±7.7 vs. 23.8±6. 1, t=2.49, P= 0.026）, andTMPG3 achievement rate was also higher （83.1G vs. 67.5%,X^2=4.05, P=0.046）. The incidence of MACE was significantly lower in tirofiban group than that in control group both within 36 hours and 30 days after procedure（6.9%vs. 19.0%, X^2=6.30, P=0.013;3.8% vs. 11.90 %, X^2 = 5.82, P = 0. 018, respectively）. No statistical difference was found in mild bleeding complications between the two groups （20.2%vs. 15.2%, X^2 =3.65, P=0. 065）, but the incidence of mild bleeding was higher in aged group than that in the non-elderly group（25.0% vs

关 键 词：冠状动脉疾病 血管成形术 经腔 经皮冠状动脉 替罗非班 抗凝药 

分 类 号：R686[医药卫生—骨科学]