替罗非班联合瑞替普酶治疗急性心肌梗死的有效性及安全性研究  

Combination reperfusion therapy of firofiban and haft - dose reteplase in STEMI

作　　者：卞秋武[1] 林海龙[2] 张双月[1] 孙丽敏[1] 杨红梅[1] 王庆胜[1] 谭强[1] 王雪青[1] 刘晓媛[1] 王晓亮[1] 

机构地区：[1]河北医科大学附属秦皇岛市第一医院心内科,河北秦皇岛066200 [2]大连大学附属大连中心医院心内科,辽宁大连116033

出　　处：《中国急救医学》2012年第9期786-789,共4页Chinese Journal of Critical Care Medicine

基　　金：基金项目：河北省科技研究与发展计划项目（072761619）

摘　　要：目的探讨替罗非班联合半量瑞替普酶溶栓应用于急性ST段抬高性心肌梗死治疗的安全性及有效性。方法入选我院急性ST段抬高性心肌梗死患者208例，年龄27—75岁，随机分为两组，联合溶栓组：瑞替普酶5U静脉注射，30min后重复上述剂量；盐酸替罗非班氯化钠注射液起始30min内0．4μg／（kg·min）静滴，继以0．1μg／（kg·min）维持36h；溶栓前予肝素45～60U／kg静注（最大量4000U），以后肝素7U／（kg·h）（最大量800U／h）维持静滴48h。瑞替普酶组：瑞替普酶10U静注，30min后重复上述剂量；溶栓前予肝素70U／kg（最大量5000U）静注，以后肝素15U／（kg·h）（最大量1200U／h）维持静滴48h。比较两组临床再通率、平均再通时间、60～90min冠状动脉TIMI血流情况、复合临床终点、出血事件发生率。结果联合溶栓组临床再通率高于瑞替普酶组，60～90min时联合溶栓组TIMI3级血流比率明显高于瑞替普酶组。联合溶栓组平均再通时间（43．3±18．4）min，明显短于瑞替普酶组[（76．9±27．1）min，P〈0．001]；联合溶栓组心肌缺血复发率、非致死性心肌再梗死发生率、室性心动过速发生率均低于瑞替普酶组。两组严重出血发生率、轻中度出血发生率比较差异无统计学意义。结论替罗非班联合半量瑞替普酶溶栓治疗急性心肌梗死的效果优于标准瑞替普酶溶栓，安全性相似。Objective To investigate therapeutic efficacy and safety of combination reperfusion therapy tirofiban with half - dose reteplase in acute ST - segment elevation myocardial infarction （STEMI）. Methods 208 patients with STEMI in our hospital were randomly assigned to half - dose reteplase with full - dose tirofiban （ group A） or standard - dose reteplase （ group B）. Group A （ n = 102） received halfdose reteplase （two boluses of 5 U, 30 min apart） in combination with tirofiban[0.4 μg/ （kg · min） for 30 min followed by an infusion of 0.1 μg/（kg · min） for 36 hi. Group B（n = 106） received reteplase at the standard dose of two 10 U boluses, 30 min apart. All the patients were also given aspirin 300 mg orally at the time of randomisation, and 300 mg orally daily for the remainder of the study period. The patients in group B received standard weight - adjusted heparin[ bolus of 70 U/kg with a maximum of 5000 U; the infusion of 15 U/（kg · h） with a maximum of 1200 U/hi, while each patient in group A with tirofiban and half - dose reteplase received low dose heparin （ bolus of 45 - 60 U/kg with a maximum of 4000 U; the infusion of 7 U/（ kg · h）with a maximum of 800 U/h ]. Results The clinical recanalization rate was higher in combined thrombolysis group than in standard - dose reteplase group; The average time of clinical recanalization was shorter in combined thrombolysis group than in standard - dose reteplase group[ （43.3 ± 18.4） min vs （76.9 ± 27.1 ） min, P 〈 0. 001 ].Angiography at 60 ± 90 min showed a higher rate patency in combined thrombolysis group than in standard - dose reteplase group. There was no difference in mortality rate between combined thrombolysis group and standard - dose reteplase group, but combined thrombolysis group showed a fewer ratio in recurrent myocardial infarction, recurrent ischemia, ventricular tachycardia or fibrillation, severe pump failure. There was no difference in life - threatening bleeding ratio between combined thromb

关 键 词：溶栓治疗 急性心肌梗死(AMI) GPⅡb/Ⅲa受体拮抗剂 血小板 

分 类 号：R973.2[医药卫生—药品]