冠脉内替罗非班对急诊介入术中慢血流的作用  

Effect of intracoronary tirofiban on coronary slow flow patients with acute myocardial infarctionduring primary percutaneous coronary intervention

作　　者：李响[1] 王春梅[1] 朱小玲[1] 艾辉[1] 张倩[1] 

机构地区：[1]北京安贞医院抢救中心,北京100029

出　　处：《中华急诊医学杂志》2013年第1期69-72,共4页Chinese Journal of Emergency Medicine

摘　　要：目的观察冠脉内注射替罗非班对急诊直接冠脉介入治疗（primarypercutaneouscoronaryintervention，PPCI）中慢血流的影响。方法选择因急性心肌梗死（acutemyocardialinfarction，AMI）（缺血性胸痛发作〈12h，或≥12h但仍有缺血性胸痛）于2008年1月至2011年1月住院行PPCI并于术中出现慢血流的患者187例。根据冠脉内应用药物不同分为两组：即替罗非班组与对照组（硝酸甘油），观察两组患者的血流恢复情况、对收缩压的影响、出血及临床事件发生率。采用SPSS13．0软件分析，计量资料两组间比较采用t检验，计数资料采用X2检验，以P〈0．05为差异有统计学意义。结果两组基线资料、术前收缩压（P=0．245）、术后达到TIMI血流3级比率（P=0．568）及术后ST段回落率（P=0．824）、左室射血分数（1eftventricularejectionfraction，LVEF）（P=0．275）、病死率（P=0．502）差异均无统计学意义，而术后对照组患者收缩压显著低于替罗非班组（P=0．018），术中应用主动脉内球囊反搏（intra—aorticballoonpump，IABP）的比例也明显高于替罗非班组（P=0．031）。虽轻度出血比例替罗非班组有高于对照组的趋势，但差异无统计学意义（P=0．085）。两组均无中、重度出血发生。结论AMI患者冠脉内应用替罗非班能够达到与硝酸甘油同样地改善PPCI术中慢血流的作用，同时并不影响收缩压，安全性高，可能为合并低血压的AMI患者提供一个更好的选择。Objective To investigate the effect of intracoronary application of tirofiban on coronary slow flow patients with acute myocardial infarction during primary percutaneous coronary intervention （PPCI）. Method It was a retrospective analysis of 187 patients with acute myocardial infarction treated with PPCI in the emergency department of Beijing Anzhen Hospital enrolled in this study from January, 2008 through January, 2011. The patients divided into 2 groups in terms of intra-coronary administration of tirofiban （tirofiban group） and intra-coronary use of nitroglycerol （control group） . Data were statistically analyzed by using SPSS 13.0 software . Categorical variables were analyzed using X2 test and continuous variables were compared by t test. Results Between two groups, there were no differences in preoperative systolic pressure （ P = 0. 245 ）, the rate of TIMI flow 3 （ P = 0. 568 ） after PPCI and ST segment resolution （P = 0. 824）, LVEF （P = 0. 275 ） and in-hospital mortality （ P = 0. 502）. Compared with tirofiban group, the systolic pressure was lower and the rate of using intra-aortic counter-pulsation was higher in control group. Although the incidence of slight bleeding in the control group was lower than that in the tirofiban group, no severe bleeding was observed in both groups. Conclusions The effect of intracoronary use of tirofiban was similar to that of nitroglycerol in terms of improving slow flow of coronary artery. It could safely and effectively reduce the incidence of the coronary slow flow in the patients after PPCI, but it produced a little impact on systolic pressure. It may be a better method of choice for AMI patient with low bloodpressure.

关 键 词：冠脉内 替罗非班 慢血流 直接冠脉介入治疗 

分 类 号：R542.22[医药卫生—心血管疾病]