冠脉内小剂量替罗非班在急性STEMI急诊介入时应用观察  

Efficacy of low-dose intracoronary injection of tirofiban in patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

作　　者：赵瑞革[1] 赵月[1] 英海蓉[1] 王荣军[1] 戴路刚[1] 

机构地区：[1]阜新市中心医院心内科,辽宁阜新123000

出　　处：《心脏杂志》2014年第2期168-170,共3页Chinese Heart Journal

摘　　要：目的:探讨急性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)时冠脉内小剂量应用替罗非班对介入治疗安全性和有效性。方法:入选77例STEMI急诊介入治疗患者,全部患者入院后立即给予阿司匹林300 mg嚼服,氯吡格雷300 mg口服,随机分为替罗非班组(试药组,39例)和对照组(38例,未用替罗非班)。PCI术后梗死相关血管的心肌梗死溶栓(TIMI)血流分级、术后24 h ST段完全回落率、术后1周左心室射血分数(LVEF)、术后30 d主要心血管事件(死亡、再发心肌梗死、靶血管血运重建、反复心绞痛发作)及TIMI出血事件作为评价指标。结果:术前两组患者基线资料(年龄、性别、危险因素)差异无统计学意义。术后即刻TIMIⅢ级血流获得率试药组明显高于对照组(P<0.05)。术后24h ST段完全回落率及1周时LVEF试药组明显高于对照组(均P<0.05,P<0.01)。术后30 d随访两组主要心血管事件和主要出血事件的发生率差异均无统计学意义。结论:对急性STEMI患者急诊介入治疗时,冠脉内应用小剂量替罗非班可以获得较好的即刻造影结果,且安全、有效。AIM： To investigate the efficacy of early application of low-dose tirofiban in patients with ST-segment elevation myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention （PCI）. METHODS： A total of 77 STEMI patients were randomly divided into tirofiban group （n = 39 ） and control group （n = 38 ）. PCI was performed in all patients within 12 h after onset of STEMI and patients were given an oral bolus dose of clopidogrel 300 mg and aspirin 300 mg before PCI. Tirofiban 2/3 （ 10 μg/kg bolus） was injected into the artery （IRA） during PCI and intravenously administered for 24 h [ 0.1 μg/（kg-min） ] after PCI in tirofiban group. The thrombolysis in myocardial infarction （TIMI） flow grade, ST-segment complete recovery rate within 24 h, left ventricular ejection （LVEF） , major adverse cardiac events （MACEs, including death, re-infarction, target vessel revaseularization, recurrent angina pectoris） and TIMI bleeding events were recorded. RESULTS： Baseline data （including age, gender, risk factors and duration of hospitalization） of the two groups were comparable. Immediate TIMI flow grade after PCI in low-dose tirofiban group was significantly higher than in control group （ all P 〈 0. 05）. ST-segment complete recovery rate within 24 h and LVEF at 1 week in low-dose tirofiban group were also significantly higher than in control group （P 〈0. 05, P 〈0. 01 ）. MACE rate in the two groups at 1 month was similar （P 〉 0. 05 ） and the incidence of major bleeding in the two groups was also similar. CONCLUSION： Intracoronary application of low-dose tirofiban during primary PCI is safe and effective for improving TIMI flow of IRA in patients with STEMI during primary PCI.

关 键 词：替罗非班 心肌梗死 急性 ST段抬高型 冠状动脉介入治疗 

分 类 号：R542.2[医药卫生—心血管疾病]