替格瑞洛联合冠状动脉内注射替罗非班对STEMI急诊PCI后心肌灌注和预后的影响  

Effects of ticagrelor combined with intracoronary injection of tirofiban on myocardial perfusion and clinical prognosis after emergency PCI for patients with acute ST-segment elevation myocardial infarction

作　　者：周召锋[1] 施亚明[1] 王斌[1] 杨顺清[1] 施国富[1] 陈荣敏[1] 吴春阳[1] 

机构地区：[1]东南大学医学院附属盐城医院心内科,江苏省盐城市224001

出　　处：《江苏医药》2017年第11期790-793,共4页Jiangsu Medical Journal

基　　金：盐城市科技计划项目(YK2014063)

摘　　要：目的探讨替格瑞洛联合冠状动脉内注射替罗非班对急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入治疗(PCI)后心肌灌注和临床预后的影响。方法 STEMI急诊PCI患者108例随机均分为两组:替格瑞洛组(术前口服替格瑞洛180mg和阿司匹林300mg+冠状动脉内注射替罗非班10μg/kg);氯吡格雷组(术前口服氯吡格雷600mg和阿司匹林300mg+冠状动脉内注射替罗非班10μg/kg)。比较两组PCI术后梗死相关动脉心肌梗死溶栓试验(TIMI)血流分级、校正的TIMI血流帧数(CTFC)及梗死相关血管支配的心肌组织TIMI心肌灌注分级(TMP)、PCI术后7d心功能及PCI术后6个月内主要不良心脏事件(MACE)及出血并发症。结果替格瑞洛组急诊PCI后梗死相关血管TIMI血流3级比例、心肌组织TMP 3级比例和术后7d左心室射血分数均高于氯吡格雷组(P<0.05),CTFC、慢血流或无复流比例、术后7d左心室舒张末期内径和左心室收缩末期内径低于氯吡格雷组(P<0.05)。氯吡格雷组6个月内总MACE发生率高于替格瑞洛组(18.52%vs.3.70%)(P<0.05)。结论对于STEMI行急诊PCI患者,替格瑞洛联合冠状动脉内注射替罗非班使用安全、有效,可降低6个月内MACE发生率,改善预后。Objective To explore the effects of ticagrelor combined with intracoronary injection of tirofiban on myocardial perfusion and clinical prognosis after emergency percutaneous coronary intervention（PCI）in the patients with acute ST-segment elevation myocardial infarction（STEMI）.Methods A total of 108 patients with STEMI was randomized into groups of A（treated with ticagrelor 180 mg combined with aspirin 300 mg before emergency PCI plus intravenous injection of tirofiban 10μg/kg）and B（given clopidogrel 600 mg combined with aspirin 300 mg before emergency PCI plus intravenous injection of tirofiban 10μg/kg）.The post-PCI myocardial infarction thrombolysis（TIMI）blood flow classification and corrected TIMI frame counts（CTFC）in the infarct-related artery,TIMI myocardial perfusion（TMP）grades of myocardial tissues supplied by the infarct-related artery,cardiac function on the 7th day after PCI,major adverse cardiac events（MACE）within 6months of PCI and hemorrhage complications were compared between the two groups.Results The percentages of TIMI blood flow grade 3and TMP grade 3in myocardial tissues and the left ventricular ejection fraction were higher,the CTFC,slow flow or no-reflow ratio,left ventricular end-diastolic diameter and left ventricular end-systolic diameter on the 7th day after operation were lower in group A than those in group B（P〈0.05）.The incidence of total MACE events in group B was higher than that in group A（18.52% vs.3.70%）（P〈0.05）.Conclusion For STEMI patients undergoing emergency PCI,trogradil combined with intracoronary injection of tirofiban is safe and effective,which can reduce the incidence of MACE within 6months and improve the prognosis.

关 键 词：心肌梗死 经皮冠状动脉介入治疗 替格瑞洛 替罗非班 

分 类 号：R542[医药卫生—心血管疾病]