替罗非班对急性ST段抬高型心肌梗死介入治疗的临床研究  

Clinical trial of tirofiban on interventional therapy of acute ST segment elevation myocardial infarction

作　　者：杜蕊[1] 张冬梅[1] 李颖[1] 王超[1] 刘奇[1] 刘长青[1] 

机构地区：[1]唐山工人医院心内一科,河北唐山063000

出　　处：《中国临床药理学杂志》2016年第13期1162-1165,共4页The Chinese Journal of Clinical Pharmacology

基　　金：河北省医学科学研究课题基金资助项目(ZL20140252)

摘　　要：目的研究冠状动脉内注射替罗非班在急性ST段抬高型心肌梗死(STEMI)冠脉介入手术治疗(PCI)中对血流动力学的影响。方法选取2011年11月至2012年11月在本院进行PCI术治疗的506例急性ST段抬高型心肌梗死例患者,用随机数字法分为试验组和对照组各253例。对照组于术中经动脉鞘管注射普通肝素5000 U,术后再皮下注射低分子肝素5000 U,连续5 d;试验组于PCI术前,注射替罗非班5μg·kg^(-1),3 min内注射完毕,随后以0.15μg·kg^(-1)·min^(-1)持续泵入36 h。观察治疗前后2组的血流情况、心脏功能指标以及再灌注指标变化情况。结果治疗前,2组患者经溶栓治疗后血流分级(TIMI)比较差异无统计学意义(P>0.05)。治疗后与治疗前比较,2组患者的TIMI均明显改善(P<0.05),但试验组明显优于对照组(P<0.05)。治疗前,2组患者射血分数(LEVF)分别为(43.11±3.25)%,(42.69±3.22)%、左心室舒张末期内径(LVEDD)分别为(41.05±3.22)mm,(41.09±3.31)mm、左心室收缩末期内径(LVESD)分别为(31.66±4.65),(31.05±4.59)mm,2组比较差异无统计学意义(P>0.05);治疗后与治疗前比较,2组的各项心脏功能指标均明显改善,但试验组的LEVF值为(58.14±6.85)%明显高于对照组(46.12±4.15)%,而LVEDD为(43.11±3.12)mm、LVESD为(34.01±5.17)mm明显低于对照组(49.79±4.52)mm,(39.88±5.13)mm(P<0.05)。患者动脉血流量分级在90 min ST段回落>50%的CK-MB峰值以及CK-MB峰值时间等各项指标,试验组均明显优于对照组(P<0.05)。结论 STEMI在PCI中,冠状动脉内注射替罗非班可有效改善患者血流动力学,并使心功能得到较好地恢复。Objective To explore the effect of tirofiban intracoronary injection on hemodynamics in patients with acute ST- segment elevation myocardial infarction（ STEMI） after percutaneous coronary intervention（ PCI）. Methods Five hundred and six cases of patients with acute STEMI in our hospital from November 2011 to November 2012 were selected,who were divided into experiment group and control group according to the random digital table method,with 253 cases in each group.The control group were treated heparin 5000 U by intraoperative arterial sheath injection during PCI operation,after operation who were treated with low molecular weight heparin subcutaneous injection of 5000 U,for5 d. The experiment group were given injection of tirofiban by the dose in5 μg·kg^-1,completing within 3 min before PCI operation,and then the tirofiban for 36 h of continuous infusion,in0. 15 μg·kg^（-1）·min^-1. The changes of blood flow,heart function indexes and reperfusion indexes were observed before and after treatment in two groups. Results There was no significant difference in TIMI blood flow between the two groups before treatment（ P〈0. 05）,which were significantlly improved compared with those before treatment（ P〈0. 05）,and the blood flow of the experiment group after treatment was obviously better than that of the control group（ P〈0. 05）. There were no significant differences in left ventricular ejection fraction（ LVEF） [（ 43. 1 ± 3. 25） %vs（ 42. 69 ± 3. 22） % ],left ventricular end diastolic diameter（ LVEDD） [（ 41. 05 ± 3. 22） mm vs（ 41. 09 ± 3. 31）mm],left ventricular end systolic diameter（ LVESD） [（ 31. 66 ± 4. 65） mm vs（ 31. 05 ± 4. 59） mm]levels between the two groups before treatment（ P〈0. 05）. The cardiac function indexes of the two groups were significantly improved after treatment than those before treatment. After treatment,the LEVF value of the experiment group was significantly higher than that of the control group[（ 58. 14 ± 6. 85） %

关 键 词：替罗非班 急性ST段抬高型心肌梗死 冠脉介入治疗 血流动力学 

分 类 号：R972[医药卫生—药品]