冠脉注射替罗非班对ST段抬高型心肌梗死患者再灌注疗效研究  

Efficacy of intracoronary tirofiban on no-reflow phenomena in patients with ST-segment elevated myocardial infarction undergoing primary percutaneous coronary intervention

作　　者：夏菲[1] 王曼萍[1] 张林[1] 覃杰[1] 

机构地区：[1]武汉亚洲心脏病医院心肺功能检测中心,武汉430022

出　　处：《中南药学》2015年第12期1331-1334,1343,共5页Central South Pharmacy

摘　　要：目的评估冠脉注射替罗非班对ST段抬高型心肌梗死患者再灌注的疗效。方法 2012年1月至2014年12月间在本院急诊科就诊1956例急性ST段抬高性心肌梗死患者接受直接经皮冠状动脉介入治疗,根据是否在患者的冠状动脉内注射替罗非班,选择其中162例无复流患者,随机分为替罗非班组和安慰剂组,各81例。结果替罗非班组患者行冠状动脉内注射替罗非班治疗后,心肌梗死溶栓(TIMI)治疗分级显著提高(P<0.001),有26(32%)例患者成功实现再灌注。而安慰剂组TIMI等级无变化(P=0.070),只有8(10%)例患者成功实现再灌注。替罗非班组的主要不良心血管事件发生率(MACE)明显降低(36%vs19%,P=0.013)。入院24 h替罗非班组血清肌钙蛋白I水平显著低于安慰剂组[(15.8±17.8)vs(24.7±18.0)ng·m L-1,P=0.002]。CK-MB水平也显著低于安慰剂组[(96.1±79.0)vs(163.7±106.9)U·L-1,P<0.001]。结论对无复流患者行替罗非班冠脉给药可改善患者心肌灌注状况,避免患者心肌损害的发生。Objective To evaluate the efficacy of intracoronary administration of tirofiban on no-reflow phenomena in patients with ST-segment elevated myocardial infarction undergoing primary percutaneous coronary intervention. Methods Totally 1956 patients in the emergency department of our hospital from 2012 January to 2014 December underwent primary percutaneous coronary intervention. According to whether patients had coronary artery injection of tirofiban, the 162 no-reflow patients were randomly divided into 2 groups： the tirofiban team（n = 81） and the placebo team（n = 81）. Results After the administration of intracoronary tirofiban, the thrombolysis in myocardial infarction（TIMI） flow grade significantly increased（P〈0.001） and successful reperfusion was achieved in 26（32%） patients. In the placebo group, however, after the administration of intracoronary placebo, the TIMI flow grade did not change（P= 0.070）, and successful reperfusion was achieved only in 8（10%） patients. In-hospital major adverse cardiac events（MACE） were significantly lower in the tirofiban group（36% vs 19%, P = 0.013）. The 24 h admission tirofiban serum troponin I levels were significantly lower than that of the placebo group [（15.8±17.8） vs [（24.7±18.0） ng·m L-1, P = 0.002]. CK-MB levels were also significantly lower than in the placebo group [（96.1±79.0） vs（163.7±106.9） U·L- 1, P〈0.001]. Conclusion For no-reflow patients, coronary flow tirofiban administration may improve the myocardial perfusion and avoid myocardial damage.

关 键 词：替罗非班 ST段抬高型心肌梗死 无复流 

分 类 号：R542.22[医药卫生—心血管疾病]