急性心肌梗死急诊介入术中冠脉内应用替罗非班的近期疗效评价  

Short-term curative effect of intracoronary tirofiban during emergency intervention in patients with acute myocardial infarction

作　　者：李文[1] 张鸿举[1] 王相智[1] 梁毅[1] 丁少娟 

机构地区：[1]江苏省徐州市第一人民医院心内科,徐州221002

出　　处：《中国循证心血管医学杂志》2011年第3期189-192,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨急性ST段抬高心肌梗死(STEMI)患者接受经皮冠状动脉介入术(PCI)治疗中,冠状动脉(冠脉)内应用血小板糖蛋白Ⅱb/IIIa(GPⅡb/Ⅲa)受体阻断药替罗非班对冠脉灌注、心肌灌注及临床预后的影响。方法连续入选87例发生急性STEMI并行急诊PCI的患者,入选患者随机分为冠脉内应用替罗非班组(冠脉组,n=45)与静脉内应用替罗非班组(静脉组,n=42)。冠脉组在支架释放后即刻在冠脉内3min注入替罗非班12μg/kg作为负荷量,随后以0.15μg/(kg·min)静脉维持24～48h;静脉组在支架释放后3min内静脉注入替罗非班12μg/kg作为负荷量,随后以0.15μg/(kg·min)静脉维持24～48h;术后随访3个月。比较两组患者PCI术后即刻梗死相关血管的TIMI血流分级(TFG)、校正的TIMI血流帧数计数(CTFC)、TIMI心肌灌注分级(TMPG)及心肌灌注显影分级(MBG);并比较两组PCI术后1周心脏超声指标、住院期间以及随访期间主要心脏不良事件发生率。结果 PCI术后即刻两组TFG、CTFC、TMPG、MBG均无显著差异(P均>0.05),给予替罗非班冠脉内或静脉内给药后,两组TFG、CTFC、MBG、TMPG指标均较未给药前显著改善,冠脉给药组TFG、CTFC优于静脉给药组,差异有统计学意义(P<0.05～0.01)。两组PCI术后1周心超结果(LVEF、LVEDD、LVESD)未见显著差异(P>0.05);两组院内MACE事件发生率未达到统计学差异(P>0.05),1月和3月随访期MACE发生率两组亦未见显著差异(P>0.05)。结论 STEMI行急诊PCI治疗的患者,冠状动脉内应用替罗非班可显著地改善梗死相关血管的微循环血流,患者耐受性好,安全性高。Objective To investigate the influences of tirofiban（a blocker of intracoronary platelet glucoprotein receptor IIb/IIIa） on coronary perfusion,myocardial perfusion and clinical prognosis in the patients with acute ST-elevation myocardial infarction（STEMI） during percutaneous coronary intervention（PCI）.Methods The patients（n=87） with acute STEMI undergoing emergency PCI were chosen and randomly divided into the group of intracoronary tirofiban（intracoronary group,n=45） and group of intravenous tirofiban（intravenous group,n=42）.In the intracoronary group,tirofiban（12 μg/kg） was injected into the coronary artery for 3 minutes as loading dose at once after stent released followed by keeping intravenous open[0.15 μg/（kg·min）]for 24~48 hours.In the intravenous group,tirofiban（12 μg/kg） was injected into the vein within 3 minutes after stent released as loading dose followed by keeping intravenous open[0.15 μg/（kg·min）]for 24-48 hours.Two groups were followed up for 3 months after the treatment.The immediate TIMI flow grades（TFG）,corrected TIMI frame count（CTFC）,TIMI myocardial perfusion grades（TMPG） and myocardial blush grades（MBG） in infarct-related artery after PCI were compared between two groups.The echocardiography indexes and incidence rate of major adverse cardiac events（MACE） in hospital and during follow-up period were compared between two groups one week after PCI.Results The immediate TFG,CTFC,TMPG and MBG had no significant difference between two groups after PCI（all P0.05）.After treatment TFG,CTFC,MBG and TMPG were significantly improved in two groups,and the improvements of TFG and CTFC in the intracoronary group were superior to those in the intravenous group（P0.05~0.01）.One week after PCI the echocardiography（LVEF,LVEDD and LVESD） showed no significant difference between two groups（P0.05）.The incidence rate of MACE in hospital had no statistical difference between two groups（P0.05）,and had no significant difference too

关 键 词：ST段抬高心肌梗死 经皮冠状动脉介入术 替罗非班 心肌灌注 

分 类 号：R541.4[医药卫生—心血管疾病]