冠状动脉内注射不同剂量替罗非班对老年ST段抬高型心肌梗死患者急诊介入术后近期预后的影响  

Effect of Intracoronary Use of Different Doses of Tirofiban on Short-term Prognosis in Elderly Patients with STEMI after PCI

作　　者：王环[1] 赵凤琴[2] 

机构地区：[1]辽宁医学院附属第三医院心内科,辽宁省锦州市121000 [2]辽宁医学院附属第三医院体检中心,辽宁省锦州市121000

出　　处：《中国全科医学》2012年第32期3723-3726,共4页Chinese General Practice

摘　　要：目的探讨不同剂量血小板糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂替罗非班在ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉介入治疗(PCI)中应用的安全性和近期预后。方法入选2011年3月—2012年6月辽宁医学院附属第三医院收治的86例老年STEMI患者,根据PCI冠状动脉内应用替罗非班的剂量分为大剂量组(n=48)和常规组(n=38),观察两组患者术后TIMI血流分级、ST段抬高总和回落百分比、血N-末端脑钠肽前体(NT-proBNP)水平的变化;住院期间和随访1个月时的左室射血分数(LVEF)、主要心血管事件发生率及出血事件发生率。结果大剂量组较常规组有较高的TIMI3级血流获得率(81.25%vs.57.89%),差异有统计学意义(P=0.018);大剂量组术后心电图ST段抬高总和回落百分比>50%率较常规组增高(83.33%vs.63.17%),差异有统计学意义(P=0.033);大剂量组术后第7天NT-proBNP水平较常规组降低〔(994±543)μg/L vs.(1 325±791)μg/L〕,差异有统计学意义(P=0.024);大剂量组术后1个月LVEF较常规组升高〔(57.8±11.9)%vs.(52.1±11.5)%〕,差异有统计学意义(P=0.027);大剂量组住院期间和随访1个月时主要心血管事件发生率较常规组降低,差异有统计学意义(P=0.032)。结论大剂量应用血小板GPⅡb/Ⅲa受体拮抗剂替罗非班对改善STEMI患者急诊PCI术后血流再灌注及近期临床预后具有积极作用,可进一步改善心肌微循环的灌注。Objective To investigate the safety and short-term results after the intracoronary use of different doses of Tirofiban,a platelet glycoprotein Ⅱb/Ⅲa receptor antagonist,in ST-segment elevation myocardial infarction patients who were treated by percutaneuos coronary intervention（PCI）.Methods A total of 86 elderly patients with STEMI who were treated by emergency PCI were divided into high-dose group（n=48） and conventional-dose group（n=38） from March 2011 to June 2012 in the Third Affiliated Hospital of Liaoning Medical University.The TIMI flow grade,the descended percentage of the total ST-segment elevation,and blood NT-proBNP level were observed.The changes of left ventricular ejection fraction,cardiovascular events,and bleeding were observed during hospitalization and one month after PCI.Results High-dose group showed significantly higher TIMI3 flow degree than that of conventional-dose group（81.25% vs.57.89%,P=0.018）.Compared with conventional-dose group,the descended percentage of the postoperative total ST-segment elevation50% was significantly higher（83.33% vs.63.17%,P=0.033）,although the NT-proBNP was significantly lower after PCI in high-dose group than that of conventional-dose group（（994±543）μg/L vs.（1 325±791）μg/L,P=0.024）.Furthermore,the high-dose group had significantly higher LVEF than that of conventional-dose group（（57.8±11.9）% vs.（52.1± 11.5）%,P=0.027）.The cardiovascular events in high-dose group was less frequent during hospital stay and one month after PCI（P=0.032）.Conclusion Intracoronary application of high-dose Tirofiban during primary PCI in STEMI patients is safe and effective in improving blood flow perfusion and clinical prognosis.

关 键 词：血小板糖蛋白Ⅱb Ⅲa受体拮抗剂 替罗非班 ST段抬高型心肌梗死 血管成形术 经腔 经皮冠状动脉 

分 类 号：R542.22[医药卫生—心血管疾病]