PCI术前早期和即刻应用替罗非班对高危ACS患者冠脉血流和心肌灌注的影响比较  

Effects of Early before PCI and Immediate Application of Tirofiban on Coronary Blood Flow and Myocardial Perfusion in Patients with High Risk Acute Coronary syndrome

作　　者：张琮[1] 李玉敏[2] 

机构地区：[1]南阳医学高等专科学校第一附属医院心血管内科,河南南阳473000 [2]南阳医学高等专科学校第二附属医院心血管内科,河南南阳473000

出　　处：《中国药房》2016年第20期2813-2815,共3页China Pharmacy

摘　　要：目的：比较经皮冠状动脉介入治疗（PCI）术前早期和即刻应用替罗非班对高危急性冠状动脉综合征（ACS）患者冠脉血流和心肌灌注的影响。方法：100例高危ACS患者根据随机数字表法分为观察组和对照组,各50例。两组患者均应用替罗非班,其中观察组患者于PCI术前4~6 h给药,剂量为10μg/kg,3 min内完成静脉注射,而后以0.15μg/（kg·min）的速度静脉泵注,用药至PCI术后24 h;对照组患者于PCI术开始时应用,给药方法同观察组。比较两组患者治疗前后的心肌梗死溶栓治疗（TIMI）血流分级、TIMI心肌灌注分级（TMPG）、肌钙蛋白Ⅰ（c TnⅠ）水平、血小板聚集率（PAR）及主要心脏不良事件（MACE）的发生率。结果：治疗后,两组TIMI血流分级2~3级及TMPG 2~3级的患者例数均显著多于治疗前,且观察组TMPG 2~3级的患者例数显著多于对照组,差异均有统计学意义（P〈0.05）。治疗后,两组患者的c TnⅠ均显著升高,PAR均显著降低,与治疗前比较差异有统计学意义（P〈0.05）,但组间比较差异无统计学意义（P〉0.05）。观察组患者的MACE发生率（8.0%）与对照组（16.0%）比较,差异无统计学意义（P〉0.05）。结论：PCI术前早期应用替罗非班可以有效改善高危ACS患者的冠脉血流及心肌血供。OBJECTIVE： To investigate the effects of early before PCI and immediate application of tirofiban on coronary blood flow and myocardial perfusion in patients with high risk acute coronary syndrome （ACS）. METHODS： 100 high risk ACS patients were randomly divided into observation group and control group, with 50 cases in each group. Two groups were given tiro- fiban; observation group was given medicine 10 μg/kg within 3 min, 4-6 h before PCI, with the velocity of 0.15 μg/（kg.min） till 24 h after PCI. Control group was given medicine at the beginning of PCI, route of administration was same as observation group. The incidence of TIMI blood flow grading, TIMI myocardial perfusion grade （TMPG）, cTn I , PAR and main adverse cardiac events （MACE） were compared between 2 groups before and after treatment. RESULTS： After operation, the patients of 2-3 grade TIMI blood flow and 2-3 grade TMPG in 2 groups were significantly more than before; the patients of 2-3 grade TMPG in observa- tion group was significantly more than in control group, with statistical significance （P〈0.05）. After treatment, cTn I of 2 groups were significantly increased, while PAR were significantly decreased, with statistical significance compared to before operation （P〈0.05） ; but there was no difference between 2 groups （P〉0.05）. There was no statistical significance in the incidence of MACE between observation group （8.0 % ） and control group （16.0 % ） （P〉0.05）. CONCLUSIONS： Early application of tirofiban before PCI can effectively improve coronary blood flow and myocardial blood supply in high risk ACS patients.

关 键 词：替罗非班 冠状动脉介入术 急性冠状动脉综合征 冠脉血流 心肌灌注 用药时机 

分 类 号：R542.2[医药卫生—心血管疾病]