不同途径替罗非班在急性心肌梗死直接经皮冠状动脉介入治疗中的应用  

Safety and Efficacy with Intracoronary Use Tirofiban Therapy by different Ways in Acute Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

作　　者：周浩[1] 黄伟剑[1] 计光[1] 张怀勤[1] 

机构地区：[1]温州医学院附属第一医院心血管内科温州市心脏介入治疗中心,浙江温州325000

出　　处：《中国现代医生》2011年第16期3-5,共3页China Modern Doctor

基　　金：浙江省温州市2008年第二期科技计划项目;基金项目号:Y20080237

摘　　要：目的观察不同途径负荷替罗非班对急性心肌梗死直接经皮冠状动脉介入治疗的有效性和安全性。方法选择因急性ST段抬高心肌梗死入院、并接受直接急诊经皮冠状动脉介入治疗患者92例,分为试验组(冠脉内负荷替罗非班+PCI)42例和对照组(静脉负荷替罗非班+PCI)50例。观察两组PCI术前、术后TIMI血流情况,术后心电图ST段回落指数,30d主要心血管事件(心绞痛,再次心肌梗死和死亡)及出血、血小板减少症、输血等的发生。结果 试验组PCI术前梗死相关血管各级TIMI血流与对照组无显著性差异。试验组PCI术后即刻达TIMI 3级血流比例高于对照组(P<0.05),PCI术后30min达到TIMI 3级血流比例也显著高于对照组(P<0.05),术后2h、4h心电图ST段回落指数均高于对照组(P<0.05)。试验组30d内主要心血管事件的发生率较对照组降低66%(P<0.05)。两组间所有出血相关并发症无显著性差异(P>0.05)。结论 冠脉内负荷替罗非班在急性心肌梗死直接经皮冠状动脉介入治疗中改善术后心肌灌注,降低心血管事件,并不增加出血的风险。Objective To determine Safety and efficacy with intracoronary use of tirofiban therapy by different ways in acute myocardium infarction（STEMI） treated by primary percutaneous coronary intervention. Methods The ninety-two STEMI patients were randomized to receive intracoronary use and intravenous use loadiong dose （10μg/kg） group follow by continuous intravenous injection （0.15μg.kg-1.min-1） for 24 hours. The TIMI flow grate before and after the operation were reviewed. STRI were measured after PCI. The primary end points include angina pectoris, re-myocardial infarction and death. The incidences of minor bleeding,major bleeding, thrombocytopenia and transfusion were compared. Results There was no difference of TIMI flow between the two groups before PCI. A greater percentage of TIMI grate 3 flow was achieved in group of patients with intracoronary use compared with intravenous use loading dose group after immediate PCI （P〈0.05） and thirty minutes after PCI. STRI were greater in group of patients with intracoronary use than intravenous use loading dose group at 2h,4h after PCI（P〈0.05）. The frequency of the primary end points at 30 days was lower in intracoronary use group compared with intravenous use group （P〈0.05）. There was no difference of hemorrhagic complications between the two groups. Conclusion Intracoronary use loading dose tirofiban is safe and effect in Chinese patients with STEMI patients treated by primary PCI.

关 键 词：急性心肌梗死 替罗非班 安全性 

分 类 号：R542.2[医药卫生—心血管疾病]