急性心肌梗死急诊经皮冠状动脉介入时冠状动脉内不同剂量替罗非班治疗的疗效比较  

Efficacy comparison of different dose intracoronary Tirofiban during primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction

作　　者：房兆飞[1] 陈国雄[1] 王红娜[1] 方波[1] 孔倩雯[1] 邹金林 邬小花 FANG ZhaoFei;CHEN GuoXiong;WANG Hongna(Cardiology Departmentof Zhoushan＇s Hospital,Zhoushan 316000,China)

机构地区：[1]浙江省舟山医院心内科,316000

出　　处：《心电与循环》2018年第6期385-389,共5页Journal of Electrocardiology and Circulation

基　　金：舟山市科技局项目(2016C3040)

摘　　要：目的比较急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入(PCI)中冠状动脉内注射不同剂量替罗非班的疗效。方法选择2015年4月至2017年10月在诊断为STEMI并行急诊PCI的患者采用随机数字表法分为低剂量组(术中冠状动脉内推注替罗非班10μg/kg)和高剂量组(术中冠状动脉内推注替罗非班25μg/kg),术后两组均按0.1μg/(kg·min)微泵持续静推维持至36h。比较冠状动脉梗死相关血管即刻TIMI血流、术后2h心电图ST段回落率(STR)、术后10~15d超声心动图的左心室舒张末径(LVEDD)、左心室射血分数(LVEF)、术后30d主要心血管事件。结果共纳入136例患者,术前两组一般资料可比(P>0.05)。高剂量组TIMI血流3级比率(88.2%)、术后STR(85.29%)比率均高于低剂量组(58.8%、57.32%),差异有统计学意义(χ~2=8.83、0.388,均P<0.05)。术后高剂量组LVEDD(41.26±3.62)mm、MACE发生率(8.8%)低于低剂量组[(50.68±5.64)mm、16.1%],LVEF[(55.63±5.52)%]高于低剂量组[(40.82±5.58)%],差异均有统计学意义(χ~2/t=-3.41、1.038、3.62,均P<0.05)。结论冠状动脉内注入高剂量替罗非班有利于提高STEMI患者PCI的疗效和改善近期预后。Objective To compare the efficacy of different dose intracoronary tirofiban during primary percutaneouscoronary intervention （PPCI） in patients with ST-elevation myocardial infarction （STEMI）. Methods STEMI patientsundergoing PPCI from April 2015 to October 2017 were randomly assigned to low-dose tirofiban group （10μg/kgintracoronary bolus） and high-dose tirofiban group（25μg/kg intracoronary bolus）. Intravenous tirofiban（0.1μg· kg^-1· min^-1）maintained for 36h after PPCI in both groups. Thrombolysis in myocardial infarction （TIMI） grade, ST- segment recoveryrate （STR） at 2h after operation, left ventricular end diastolic diameter （LVEDd） and left ventricular ejection fraction （LVEF）on echocardiography during 10-15days and major adverse cardiac events （MACE） at 30 days post operation werecompared. Results A total of 136 cases were enrolled. Baseline data were similar between the two groups. The ratio ofTIMI flow grade 3 and STR were significantly higher in high-dose tirofiban group than in low-dose tirofiban group. LVEDdand MACE incidence were significantly lower and LVEF was significantly higher in high-dose tirofiban group than inlow-dose tirofiban group. Conclusion Intracoronary bolus of high-dose tirofiban may improve PPCI efficacy andshort-term prognosis of patients with STEMI.

关 键 词：替罗非班 冠状动脉内注射 急性ST段抬高型心肌梗死 急诊冠状动脉介入 

分 类 号：R542.22[医药卫生—心血管疾病]