小剂量替罗非班在急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后的应用  

Application of Small Dose of Tirofiban in Patients with Acute ST-Segment Elevation Myocardial Infarction after Undergoing Percutaneous Coronary Intervention

作　　者：薛小荣[1] 李卫红[1] 王惠川[1] 王芳[1] 张桂贞[1] 刘宇凡[1] 

机构地区：[1]西安市第四医院药剂科,西安710004

出　　处：《中国医院用药评价与分析》2013年第7期646-649,共4页Evaluation and Analysis of Drug-use in Hospitals of China

摘　　要：目的:探讨小剂量替罗非班对急性ST段抬高型心肌梗死(STEMI)患者经皮冠脉介入治疗(PCI)术后的疗效和安全性。方法:入选我院进行急诊PCI的STEMI患者,以随机抽样法分为急诊PCI联合观察组(观察组)和单纯急诊PCI组(对照组)。观察组于PCI术后加用替罗非班,起始注射剂量为5μg/kg,在3 min内注射完毕,而后以0.075μg/kg/min持续微量泵静脉泵入48h;2组患者其他用药相同。观察比较2组患者术后1 h ST段回落情况及住院期间和术后30 d主要心脏不良事件(MACE)发生率,并记录各例患者术前和使用替罗非班后6 h的血红蛋白值(HGB)和血小板计数(PLT),记录有无发生出血情况。结果:2组患者一般临床情况、介入治疗结果差异均无统计学意义。观察组患者术后1 h 12导联心电图的ST段回落值(∑STR)比对照组显著增加,分别为(0.46±0.09)、(0.39±0.12)mV(P<0.05)。住院期间,观察组与对照组MACE发生率无明显差异。术后30 d,观察组再梗死发生率比对照组显著降低(分别为3.4%、25.0%,P<0.05)。观察组患者总出血并发症、严重出血及轻度出血发生情况,与对照组比较差异无统计学意义,2组均未出现血小板减少症的患者。观察组和对照组患者HGB、PLT值基线及每组术前和使用替罗非班后6 h HGB、PLT值比较,差异均无统计学意义,观察组和对照组患者HGB、PLT下降值比较亦无统计学意义。结论:小剂量替罗非班可能对STEMI患者PCI术后具有较好的改善预后作用,并且不会引起明显的出血情况。OBJECTIVE：To evaluate the efficacy and safety of small dose of tirofiban for patients with acute ST- segment elevation myocardial infarction after undergoing percutaneous coronary intervention （PCI）. METHODS： The patients with acute ST-segment elevation myocardial infarction after undergoing emergency PCI in our hospital were randomly divided into observation group and simple PCI group （control）. The patients in the observation group received add-on tirofiban postoperatively at an initial bolus dose of 5 pLg/kg （injection was completed within 3 minutes） followed by a dose of 0. 075 p^g/kg/min by continuous intravenous infusion in 48 hrs. The other medications for the two groups were the same. The ST-segment recovery at 1 h after operation and the incidence of major adverse cardiac events （MACE） at 30 days after operation were observed. The hemoglobin and platelet levels before operation and at 6 hours after administration of tirofiban and the bleeding events were recorded. RESULTS ： No statistically significant differences were noted between the two groups with regard to general clinical status and theefficacy of interventional therapy. The ST-segment recovery （ESTR） in 12-lead ECG in the observation group increased significantly compared with the control group [ （0. 46 _＋ 0. 09 ） mV vs. （ 0. 39 ＋ 0. 12 ） mV, P 〈 0. 05 l- During hospitalization, the incidence of MACE was similar in the two groups. The occurrence of reinfarction in 30 days after operation in tirofiban group was significantly lower than in the control group （3.4% vs. 25% , P 〈 0. 05 ）. The total bleeding complications, and severe or mild bleeding events have no significant differences between the two groups. Thrombocytopenia was not occurred in the two groups. There were no statistically significant difference between the two groups with regard to levels of HGB and PLT at baseline, 0 and 6 hours after administration of tirofiban and the reduction of HGB and PLT levels. CONCLUSION： Small dose of tirofi

关 键 词：小剂量 替罗非班 急性ST段抬高型心肌梗死 经皮冠状动脉介入术 

分 类 号：R972[医药卫生—药品]