应用血栓弹力图评价替罗非班对行急诊介入的ACS患者血小板聚集功能及活性的影响  

Application of Thrombelastography for Evaluating the Influence of Platelet Aggregation Function and Activity by Using Tirofiban in the Patients Who Were Undergoing Emergency Intervention with ACS

作　　者：吴亚栋[1] 李沅敏[1] 陈清勇[1] 梁昌[1] 李伟明[1] 

机构地区：[1]同济大学附属第十人民医院心内科,上海200072

出　　处：《现代生物医学进展》2013年第15期2897-2900,2828,共5页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(81270193)

摘　　要：目的:应用血栓弹力图评估(TEG)替罗非班对急性冠脉综合症(ACS)患者血小板聚集功能及活性情况,探讨对于ACS患者行急诊介入时,早期应用替罗非班对介入治疗效果的影响。方法:入选100例拟行急诊介入治疗的ACS患者,于冠状动脉造影前随机分为干预组(在3分钟内推注替罗非班组10μg/kg,以0.15μg/kg/min速度静脉维持泵入36小时,共50例)和对照组(不应用替罗非班,共50例),分别于入选后即刻、替罗非班应用后24小时、停用后24小时抽血,采用血栓弹力图记录血小板聚集功能的抑制率(IPA)及活性。结果:两组之间的入选后即刻IPA差异无统计学意义(P>0.05),替罗非班应用后24小时血小板聚集抑制水平达到高峰,IPA为(92.6±8.6)%,显著高于对照组[(33.3±9.8)%,P<0.01],停用替罗非班后24小时,两组之间的IPA差异无统计学意义(P>0.05)。替罗非班应用24小时后,血小板活性显著低于对照组[(46.7±10.2)mm比(59.7±7.8)mm,P<0.01]。结论:TEG能动态监测凝血功能全过程,全面评估血小板功能及凝血情况,指导ACS患者抗血小板药物方案选择。在进行介入治疗的ACS患者中早期应用替罗非班较常规口服药物能更好地达到血小板聚集抑制作用,可以获得更好的即刻造影结果,减少术后缺血性事件发生,提高临床预后情况。Objective： To discuss the application of thrombelastography for evaluating the influence of platelet aggregation function and activity by using Tirofiba in the patients who were undergoing emergent intervention with ACS,and to investigate the efficacy and safety of early application of tirofiban on the patients.Methods： 100 cases who were undergoing emergency intervention with ACS were selected and randomly divided into two groups： intervention group（injected tirofiban by 10 μg/kg in 3 minutes,then 0.15 μg/kg/min for 36 hours by,n=50） and control group（without tirofiban,n=50）,collectedg blood in 3 times（Immediately divided in groups,after kept tirofiban for 24 hours and after stoping for 24 hours）,and recorded inhibition of platelet aggregation rate（IPA）and activity.Results： There was no statistical significance between the two groups（P0.05） when selected.After kept tirofiban for 24 hours,the IPA of intervention group was significantly higher than that of control group[（92.6±8.6）% vs（33.3±9.8）%,P0.01].24 hours after tirofiban stopped,the IPA of the two groups was not statistically significant（P0.05）.The activity of platelet was significantly lower than that of the control group[（46.7±10.2）mm vs（59.7±7.8）mm,P0.01].Conclusions： TEG can dynamicaly monitor the function of blood coagulation process and comprehensively assess platelet function and blood coagulation,as well as guiding the plan selection of antiplatelet drugs in ACS patients.The earlier to use tirofiban before emergency intervention in patients with ACS,the better effects we get.It is able to achieve better platelet aggregation inhibition,obtain better immediate angiography results,reduce postoperative ischemic events and improve clinical prognosis.

关 键 词：急性冠脉综合症 血小板聚集抑制剂 血栓弹力图 替罗非班 

分 类 号：R541.4[医药卫生—心血管疾病]